Basic Information
| Provider Information | |||||||||
| NPI: | 1598785685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROSSMAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 1ST AVE APT 11F | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100104935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122604375 | ||||||||
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| Practice Location | |||||||||
| Address1: | 845 N BROADWAY | ||||||||
| Address2: | WJCS | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106032403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147610600 | ||||||||
| FaxNumber: | 9147615367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R014239 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 198580 | 01 | NY | HEALTHNET | OTHER |