Provider Demographics
NPI:1518292820
Name:GRUBER, JEFF (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:GRUBER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E PARENT AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3768
Mailing Address - Country:US
Mailing Address - Phone:248-325-8197
Mailing Address - Fax:
Practice Address - Street 1:628 E PARENT AVE STE 302
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3768
Practice Address - Country:US
Practice Address - Phone:248-325-8197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011899103TC0700X
MI6301014892103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical