Provider Demographics
NPI:1982481222
Name:MONTERUBIO, GRACE ELISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ELISE
Last Name:MONTERUBIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PARK AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2514
Mailing Address - Country:US
Mailing Address - Phone:314-640-5597
Mailing Address - Fax:
Practice Address - Street 1:3800 PARK AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2514
Practice Address - Country:US
Practice Address - Phone:314-640-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022038818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical