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NPI Code Detail

MEDICARE: JENNIFER GROSSMAN LCSW

MEDICARE: JENNIFER GROSSMAN LCSW
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
1104100000XSocial Worker088416-1NY
21041C0700XClinical Social Worker086057-1NY

General Provider Information

NPI Number : 1285067850
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GROSSMAN LCSW
Provider Business Mailing Address
First Line : 1765 SOUTH AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3604
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1765 SOUTH AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3604
Country : US
Telephone Number : 718-761-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2013
Last Update Date : 03/17/2018

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Directions to “ JENNIFER GROSSMAN LCSW” Practice Location

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