Healthcare Provider Details

I. General information

NPI: 1902102403
Provider Name (Legal Business Name): CAROL L. GROSS, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5551 N UNIVERSITY DR #202
CORAL SPRINGS FL
33067-4651
US

IV. Provider business mailing address

8705 NW 29TH DR
CORAL SPRINGS FL
33065-5328
US

V. Phone/Fax

Practice location:
  • Phone: 954-592-0329
  • Fax: 954-796-1070
Mailing address:
  • Phone: 954-344-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4487
License Number StateFL

VIII. Authorized Official

Name: MS. CAROL L. GROSS
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 954-592-0329