Provider Demographics
NPI:1497957484
Name:GRUBER, BARRY L (PHD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:GRUBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 HARMONY LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5719
Mailing Address - Country:US
Mailing Address - Phone:410-266-8555
Mailing Address - Fax:410-266-5328
Practice Address - Street 1:49 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:STE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3864
Practice Address - Country:US
Practice Address - Phone:410-266-8555
Practice Address - Fax:410-266-5328
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1622103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist