MEDICARE: SASHA GROSSMAN LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	097890	NY

General Provider Information

NPI Number	:	1023540069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SASHA GROSSMAN LMSW

Provider Business Mailing Address
First Line	:	395 5TH ST
Second Line	:	APARTMENT 2
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 5TH ST
Second Line	:	APARTMENT 2
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2806
Country	:	US
Telephone Number	:	973-634-0666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	10/09/2019

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