Provider Demographics
NPI:1710079488
Name:GRUBB, EDGAR LEE JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:LEE
Last Name:GRUBB
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
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Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-334-3700
Mailing Address - Fax:210-922-0162
Practice Address - Street 1:1 HAVEN FOR HOPE WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-1108
Practice Address - Country:US
Practice Address - Phone:210-220-2330
Practice Address - Fax:210-220-2332
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX32385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker