Basic Information
| Provider Information | |||||||||
| NPI: | 1962848564 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSSMAN | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ELIZABETH BARRETT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PSYD, MSED | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BARRETT | ||||||||
| OtherFirstName: | LAUREN | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 UNIVERSITY DR | ||||||||
| Address2: | PO BOX 850 | ||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170332360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 7175316491 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 UNIVERSITY DR | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY | ||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170332360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175316386 | ||||||||
| FaxNumber: | 7175316491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2013 | ||||||||
| LastUpdateDate: | 10/07/2016 | ||||||||
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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 | 103G00000X | TPS030370 | PA | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103G00000X | 28311 | CA | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.