Healthcare Provider Details

I. General information

NPI: 1720156805
Provider Name (Legal Business Name): RICHARD ANTHONY GROSS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HANOVER ST
CARLISLE PA
17013-2421
US

IV. Provider business mailing address

45 E NORTH ST
CARLISLE PA
17013-2429
US

V. Phone/Fax

Practice location:
  • Phone: 717-218-6670
  • Fax: 717-218-6671
Mailing address:
  • Phone: 717-422-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50077950
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006346
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019774
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: