Provider Demographics
NPI:1417456146
Name:GROB, EMILY K (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:GROB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 SW 62ND BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2039
Mailing Address - Country:US
Mailing Address - Phone:850-819-4312
Mailing Address - Fax:
Practice Address - Street 1:2300 N FLORIDA MANGO RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6416
Practice Address - Country:US
Practice Address - Phone:561-296-4887
Practice Address - Fax:561-472-9939
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW124411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical