Healthcare Provider Details

I. General information

NPI: 1124974753
Provider Name (Legal Business Name): MARIO GROSS LSW, MSW, M.DIV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 S RACE ST APT 101
DENVER CO
80210-5165
US

IV. Provider business mailing address

3800 BUCHTEL BLVD # 100141
DENVER CO
80210-9998
US

V. Phone/Fax

Practice location:
  • Phone: 909-846-2483
  • Fax:
Mailing address:
  • Phone: 720-557-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0009927732
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: