Provider Demographics
NPI:1821977083
Name:GRUPP, MAIRE CATHERINE (LSW)
Entity type:Individual
Prefix:
First Name:MAIRE
Middle Name:CATHERINE
Last Name:GRUPP
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 1:24007 MERRILYN CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2333
Mailing Address - Country:US
Mailing Address - Phone:317-678-7337
Mailing Address - Fax:317-204-8787
Practice Address - Street 1:136 ROXBURY PARK
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1730
Practice Address - Country:US
Practice Address - Phone:317-210-3075
Practice Address - Fax:317-204-8787
Is Sole Proprietor?:No
Enumeration Date:2025-08-30
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012642A104100000X
MI6851120663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker