Healthcare Provider Details

I. General information

NPI: 1831512920
Provider Name (Legal Business Name): LYNETTE GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

IV. Provider business mailing address

447 SUTTER ST STE 405
SAN FRANCISCO CA
94108-4618
US

V. Phone/Fax

Practice location:
  • Phone: 415-992-6155
  • Fax: 650-360-6913
Mailing address:
  • Phone: 415-992-6155
  • Fax: 650-360-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW21524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: