=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578636296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE-ELENA CATHERINE HALL GROSETT PH.D., LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 04/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2127 CROMPOND RD SUITE 104A
-----------------------------------------------------
City | CORTLANDT MANOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10567-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-737-7487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 218 SANDPIPER CT
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-329-0920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R034771-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------