Healthcare Provider Details

I. General information

NPI: 1801818117
Provider Name (Legal Business Name): ELLEN J GROSS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 4TH AVE SUITE 1100
PITTSBURGH PA
15222-2108
US

IV. Provider business mailing address

307 4TH AVE SUITE 1100
PITTSBURGH PA
15222-2108
US

V. Phone/Fax

Practice location:
  • Phone: 412-456-7566
  • Fax: 412-391-6640
Mailing address:
  • Phone: 412-456-7566
  • Fax: 412-391-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012217
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: