Individual provider Active NPI

Jessica Gruboy, MHC-LP

  • Mental Health Counselor
  • Brooklyn, NY
National Provider Identifier
1104664036
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
18-P129649-01 Issued in NY
Practice address
2222 Flatbush Ave Unit 340152
Brooklyn, NY 11234-4530
Phone
(347) 201-0868
NPI assigned
Jul 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 18-P129649-01 NY Primary

Addresses

Primary practice location

2222 Flatbush Ave Unit 340152
Brooklyn, NY 11234-4530

Mailing address

2222 Flatbush Ave Unit 340152
Brooklyn, NY 11234-4530
Phone (347) 201-0868

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
18-P129649-01NYMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1104664036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 FLATBUSH AVE UNIT 340152",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344530",
            "telephone_number": "347-201-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 FLATBUSH AVE UNIT 340152",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112344530",
            "telephone_number": "347-201-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBOY",
        "first_name": "JESSICA",
        "credential": "MHC-LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "18-P129649-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.