Healthcare Provider Details

I. General information

NPI: 1669531802
Provider Name (Legal Business Name): JANICE EILEEN GROSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 S GLEBE RD SUITE 103
ARLINGTON VA
22204-1655
US

IV. Provider business mailing address

8626 BLACKPOOL DR
ANNANDALE VA
22003-4315
US

V. Phone/Fax

Practice location:
  • Phone: 703-521-6004
  • Fax: 703-521-6342
Mailing address:
  • Phone: 703-425-2644
  • Fax: 703-425-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004601
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: