Provider Demographics
NPI:1902466394
Name:GRUBER, ALYSE M (MA)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:M
Last Name:GRUBER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N WYMORE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2822
Mailing Address - Country:US
Mailing Address - Phone:321-430-4655
Mailing Address - Fax:407-641-9081
Practice Address - Street 1:315 N WYMORE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2822
Practice Address - Country:US
Practice Address - Phone:321-430-4655
Practice Address - Fax:407-641-9081
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health