Provider Demographics
NPI:1790864221
Name:GROBLEWSKI, MARK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:GROBLEWSKI
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 1:1110 NASA PKWY
Mailing Address - Street 2:STE 545K
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3358
Mailing Address - Country:US
Mailing Address - Phone:281-482-5999
Mailing Address - Fax:281-993-2354
Practice Address - Street 1:1110 NASA PKWY
Practice Address - Street 2:STE 545K
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3358
Practice Address - Country:US
Practice Address - Phone:832-687-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX323981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000082JZOtherBLUECROSS BLUESHIELD
TX155305Medicaid
TX155305Medicaid