MEDICARE: MR. ROSS KENNETH GROSSMAN L.M.F.T.

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	106H00000X	Marriage & Family Therapist	MFC 31086	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	SUBB937	OTHER	CA	LA DMH PROVIDER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356462931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROSS KENNETH GROSSMAN L.M.F.T.

Provider Business Mailing Address
First Line	:	100 N SYCAMORE AVE APT 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2947
Country	:	US
Telephone Number	:	323-525-0577
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BLVD
Second Line	:	1010
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	323-646-4477
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	06/08/2015

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Directions to “ MR. ROSS KENNETH GROSSMAN L.M.F.T.” Practice Location

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