Provider Demographics
NPI:1174217962
Name:GRUBB, AMY (LSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GRUBB
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 1:6047 OLD US HIGHWAY 322
Mailing Address - Street 2:
Mailing Address - City:MILROY
Mailing Address - State:PA
Mailing Address - Zip Code:17063-9427
Mailing Address - Country:US
Mailing Address - Phone:717-953-2622
Mailing Address - Fax:
Practice Address - Street 1:21 GEISINGER LN
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-3400
Practice Address - Country:US
Practice Address - Phone:717-242-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1401951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical