Basic Information
| Provider Information | |||||||||
| NPI: | 1033266135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSSMAN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 N CENTRAL AVE | ||||||||
| Address2: | C/O WJCS | ||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105301912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149497699 | ||||||||
| FaxNumber: | 9149493224 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 N CENTRAL AVE | ||||||||
| Address2: | C/O WJCS | ||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105301912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149497699 | ||||||||
| FaxNumber: | 9149493224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 013428 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 200717 | 01 | NM | HEALTHNET | OTHER | 790013428NY01 | 01 | NY | ANTHEM | OTHER |