Individual provider Active NPI

Grace Elise Monterubio, PHD

  • Clinical Psychologist
  • Saint Louis, MO
National Provider Identifier
1982481222
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2022038818 Issued in MO
Practice address
3800 Park Ave FL 2
Saint Louis, MO 63110-2514
Phone
(314) 640-5597
NPI assigned
Sep 11, 2023
Last updated
Sep 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2022038818 MO Primary

Addresses

Primary practice location

3800 Park Ave FL 2
Saint Louis, MO 63110-2514

Mailing address

3800 Park Ave FL 2
Saint Louis, MO 63110-2514
Phone (314) 640-5597

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231006000459 MO Practitioner - Clinical Psychologist 4688029051 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2022038818MOMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Cardinal Glennon Childrens Hospital CurrentSince Sep 4, 2023 Accepting new patients
SSM Cardinal Glennon Children's Hospital CurrentSince Sep 4, 2023 Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

3800 Park Ave
Fl 2
Saint Louis, MO 63110
Phone (314) 577-5609

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1982481222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK AVE FL 2",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102514",
            "telephone_number": "314-640-5597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 PARK AVE FL 2",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102514",
            "telephone_number": "314-640-5597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTERUBIO",
        "first_name": "GRACE",
        "middle_name": "ELISE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-11",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2022038818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.