Healthcare Provider Details

I. General information

NPI: 1588468409
Provider Name (Legal Business Name): DAVIN GROSSMAN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST STE 550
PHOENIX AZ
85006-2820
US

IV. Provider business mailing address

PO BOX 14948
SCOTTSDALE AZ
85267-4948
US

V. Phone/Fax

Practice location:
  • Phone: 602-468-2077
  • Fax:
Mailing address:
  • Phone: 623-337-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-006145
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: