Provider Demographics
NPI:1619102209
Name:GRUBER, CAROLYN CHATTIN
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:CHATTIN
Last Name:GRUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6129 31ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1515
Mailing Address - Country:US
Mailing Address - Phone:202-686-2139
Mailing Address - Fax:202-686-2104
Practice Address - Street 1:6129 31ST ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1515
Practice Address - Country:US
Practice Address - Phone:202-686-2139
Practice Address - Fax:202-686-0210
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3015611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
731379Medicare PIN