Provider Demographics
NPI:1700820503
Name:GRUBE, SUSAN MARIE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:GRUBE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 JONAGOLD RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9797
Mailing Address - Country:US
Mailing Address - Phone:610-439-0246
Mailing Address - Fax:
Practice Address - Street 1:2091 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3211
Practice Address - Country:US
Practice Address - Phone:610-970-5234
Practice Address - Fax:610-970-0945
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACBH2254871OtherCIGNA
PA2459041000OtherMAGELLAN
PA366943OtherMHN