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General NPI Number Information
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NPI Number | 1013359736
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Entity Type | Organization
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Legal Business Name | DENISE K. GROSS, PSY.D., LLC
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 6015 111TH ST E
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City | BRADENTON
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State | FL
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Zip | 34211-9468
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Country | US
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Telephone | 941-756-0292
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Fax | 941-756-0161
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Provider Business Mailing Address
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Address Line | 6015 111TH ST E
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City | BRADENTON
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State | FL
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Zip | 34211-9468
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Country | US
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Telephone | 941-756-0292
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Fax | 941-756-0161
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | MR. ARTHUR JAMES GROSS
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Credential |
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Telephone | 941-756-0292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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