Provider Demographics
NPI:1245445022
Name:GRUENBERG, ROBERT A (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:GRUENBERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 N. GREEN BAY AVE.
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3823
Mailing Address - Country:US
Mailing Address - Phone:414-352-1144
Mailing Address - Fax:414-352-1133
Practice Address - Street 1:6213 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3823
Practice Address - Country:US
Practice Address - Phone:414-352-1144
Practice Address - Fax:414-352-1133
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical