Healthcare Provider Details

I. General information

NPI: 1245169697
Provider Name (Legal Business Name): JULIAYAEL GROSS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NARBERTH AVE STE 200
NARBERTH PA
19072-1822
US

IV. Provider business mailing address

450 N NARBERTH AVE STE 200
NARBERTH PA
19072-1822
US

V. Phone/Fax

Practice location:
  • Phone: 215-645-2564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0011558
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS020525
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: