Basic Information
| Provider Information | |||||||||
| NPI: | 1043631344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSSMAN-ORR | ||||||||
| FirstName: | MAREIDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 GARRETT ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274063413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367723392 | ||||||||
| FaxNumber: | 8664045622 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N EUGENE ST | ||||||||
| Address2: | MONARCH | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274012221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366766840 | ||||||||
| FaxNumber: | 8664045622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2014 | ||||||||
| LastUpdateDate: | 01/04/2014 | ||||||||
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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 | C007173 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.