MEDICARE: DR. JODY BETH GROSS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	7266	FL

General Provider Information

NPI Number	:	1740986868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODY BETH GROSS PHD

Provider Business Mailing Address
First Line	:	6461 PINETREE DR
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-4541
Country	:	US
Telephone Number	:	305-720-8985
Fax Number	:	305-720-8985

Provider Business Practice Location Address
First Line	:	6461 PINETREE DR
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-4541
Country	:	US
Telephone Number	:	305-720-8985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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