Healthcare Provider Details

I. General information

NPI: 1407791759
Provider Name (Legal Business Name): MS. MARYANN GROSSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 FILLMORE ST # 145
SAN FRANCISCO CA
94123-4009
US

IV. Provider business mailing address

25 GREGORY DR
FAIRFAX CA
94930-1004
US

V. Phone/Fax

Practice location:
  • Phone: 415-444-6262
  • Fax:
Mailing address:
  • Phone: 914-625-6527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: