Healthcare Provider Details

I. General information

NPI: 1407111933
Provider Name (Legal Business Name): ROGER GROSSMAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3761 PARK BOULEVARD WAY APT 405
OAKLAND CA
94610-2843
US

IV. Provider business mailing address

3761 PARK BOULEVARD WAY APT 405
OAKLAND CA
94610-2843
US

V. Phone/Fax

Practice location:
  • Phone: 914-907-1497
  • Fax:
Mailing address:
  • Phone: 914-907-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number98803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: