MEDICARE: DR. CAROLYN GROSSO PSYD

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	103TH0100X	Health Service Psychologist	014603	NY

General Provider Information

NPI Number	:	1841655750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN GROSSO PSYD

Provider Business Mailing Address
First Line	:	132 GREEN LN
Second Line	:	SUITE C
City	:	BEDFORD HILLS
State	:	NY
Zip	:	10507-1533
Country	:	US
Telephone Number	:	914-666-0977
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 GREEN LN
Second Line	:	SUITE C
City	:	BEDFORD HILLS
State	:	NY
Zip	:	10507-1533
Country	:	US
Telephone Number	:	914-666-0977
Fax Number	:

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

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	12/18/2015

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