Provider Demographics
NPI:1760511596
Name:GRUBB, LARRY (LCSW)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:GRUBB
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 OLD GRAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2708
Mailing Address - Country:US
Mailing Address - Phone:847-336-5621
Mailing Address - Fax:847-336-2594
Practice Address - Street 1:4212 OLD GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2708
Practice Address - Country:US
Practice Address - Phone:847-336-5621
Practice Address - Fax:847-336-2594
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical