Provider Demographics
NPI:1295785350
Name:GRUBER, ROBERT A (MS LPC LSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:GRUBER
Suffix:
Gender:M
Credentials:MS LPC LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 6TH AVENUE NORTH
Mailing Address - Street 2:ST CLOUD HOSPITAL
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1901
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-229-5109
Practice Address - Street 1:713 ANDERSON AVE
Practice Address - Street 2:ST CLOUD HOSPITAL RECOVERY PLUS
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-229-3761
Practice Address - Fax:320-229-3763
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12198104100000X
MNDD480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional