Healthcare Provider Details

I. General information

NPI: 1417153891
Provider Name (Legal Business Name): KARA GROSS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 04/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 BRUNSWICK RD
MEMPHIS TN
38133-4105
US

IV. Provider business mailing address

2911 BRUNSWICK RD
MEMPHIS TN
38133-4105
US

V. Phone/Fax

Practice location:
  • Phone: 901-373-0935
  • Fax: 901-373-0984
Mailing address:
  • Phone: 901-373-0935
  • Fax: 901-373-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW0000006594
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5058
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: