=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629054572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOWARD GROSSMAN LCSW PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 492 ROUTE 57 W
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-689-1000
-----------------------------------------------------
Fax | 908-689-4529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 WHISPER WAY E
-----------------------------------------------------
City | LEDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-713-5969
-----------------------------------------------------
Fax | 908-689-4529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | NJ LCSW 44SC01479700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------