Provider Demographics
NPI:1013359736
Name:DENISE K. GROSS, PSY.D., LLC
Entity Type:Organization
Organization Name:DENISE K. GROSS, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-756-0292
Mailing Address - Street 1:6015 111TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9468
Mailing Address - Country:US
Mailing Address - Phone:941-756-0292
Mailing Address - Fax:941-756-0161
Practice Address - Street 1:6015 111TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9468
Practice Address - Country:US
Practice Address - Phone:941-756-0292
Practice Address - Fax:941-756-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty