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General NPI Number Information
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NPI Number | 1144302209
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Entity Type | Individual
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Provider Name | ELEANOR MARILYN GROSS MSW
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 10142 N 105TH WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4924
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Country | US
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Telephone | 602-622-1121
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Fax | 480-307-9660
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Provider Business Mailing Address
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Address Line | 7647 TARPON COVE CIR
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City | LAKE WORTH
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State | FL
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Zip | 33467-6930
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Country | US
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Telephone | 480-451-6563
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Fax | 480-451-7578
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW3969
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License Number State | AZ
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