Provider Demographics
NPI:1174357446
Name:GRUBB, MEGHAN (PSYD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:GRUBB
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 1:2201 RIDGEWOOD RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1193
Mailing Address - Country:US
Mailing Address - Phone:610-378-9601
Mailing Address - Fax:
Practice Address - Street 1:2201 RIDGEWOOD RD STE 400
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1193
Practice Address - Country:US
Practice Address - Phone:610-378-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist