Provider Demographics
NPI:1467678144
Name:GRUBLER, JENNIFER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:GRUBLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 TIDEWATER DR APT J1
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-5583
Mailing Address - Country:US
Mailing Address - Phone:757-233-8585
Mailing Address - Fax:
Practice Address - Street 1:850 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3300
Practice Address - Country:US
Practice Address - Phone:757-248-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical