Healthcare Provider Details

I. General information

NPI: 1346317799
Provider Name (Legal Business Name): DANIEL GROSS NP, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK ST LELAND UNIT
BEVERLY MA
01915-1790
US

IV. Provider business mailing address

85 HERRICK ST
BEVERLY MA
01915-1790
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-3000
  • Fax:
Mailing address:
  • Phone: 978-922-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number267650
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number267650
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number267650
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: