Provider Demographics
NPI:1881626729
Name:GRUVER, MARLENE ELAINE (LSW)
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:ELAINE
Last Name:GRUVER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6948 MEANDER RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8680
Mailing Address - Country:US
Mailing Address - Phone:330-533-7973
Mailing Address - Fax:
Practice Address - Street 1:104 JAVIT CT
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2409
Practice Address - Country:US
Practice Address - Phone:330-797-4050
Practice Address - Fax:330-797-4090
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00180341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH18232226700OtherSHEAKLEY UNICOMP
OH3418557621A13OtherBLUECROSS/BLUE SHIELD
OH5255599OtherAETNA
OH0560744Medicaid
OH18232226700OtherSHEAKLEY UNICOMP