Provider Demographics
NPI:1902158827
Name:GRUBER, BRIANNE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:M
Last Name:GRUBER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MINEOLA BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4064
Mailing Address - Country:US
Mailing Address - Phone:516-663-9400
Mailing Address - Fax:516-663-9480
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-9400
Practice Address - Fax:516-663-9480
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP85548103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist