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NPI Code Detail

MEDICARE: DR. DEBORAH A. GROSS PSY.D.

MEDICARE: DR. DEBORAH A. GROSS PSY.D.
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
1103TC0700XClinical Psychologist3810AZ

General Provider Information

NPI Number : 1417016254
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBORAH A. GROSS PSY.D.
Provider Business Mailing Address
First Line : 2500 E VAN BUREN ST
Second Line : MTU ASPC PHOENIX
City : PHOENIX
State : AZ
Zip : 85008-6037
Country : US
Telephone Number : 602-685-3100
Fax Number :
Provider Business Practice Location Address
First Line : 2500 E VAN BUREN ST
Second Line : MTU ASPC PHOENIX
City : PHOENIX
State : AZ
Zip : 85008-6037
Country : US
Telephone Number : 602-685-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2006
Last Update Date : 12/24/2009

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