Provider Demographics
NPI:1720012180
Name:GRUBER, HELEN E (PHD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:E
Last Name:GRUBER
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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-0127
Mailing Address - Country:US
Mailing Address - Phone:781-383-9780
Mailing Address - Fax:
Practice Address - Street 1:84 JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1412
Practice Address - Country:US
Practice Address - Phone:781-383-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6074103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0521086Medicaid
MAW04878OtherBLUE SHIELD
MA680009813OtherRAILROAD MEDICARE
MA0521086Medicaid