Provider Demographics
NPI:1871219261
Name:ONDREY GRUBER, ELISABETH (PHD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:ONDREY GRUBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:9208 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-5904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5300 W HILLSBORO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4397
Practice Address - Country:US
Practice Address - Phone:561-600-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist