Provider Demographics
NPI:1710276639
Name:GROBER, SUSAN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:GROBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 MYSTIC PT DR
Mailing Address - Street 2:SUITE 1009
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2565
Mailing Address - Country:US
Mailing Address - Phone:786-502-8246
Mailing Address - Fax:
Practice Address - Street 1:3600 MYSTIC PT DR
Practice Address - Street 2:SUITE 1009
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2565
Practice Address - Country:US
Practice Address - Phone:786-502-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7172103T00000X
NY008928-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist