Provider Demographics
NPI:1043367576
Name:GROSS, ESTHER (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WINTHROP ROAD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4435
Mailing Address - Country:US
Mailing Address - Phone:617-731-0054
Mailing Address - Fax:
Practice Address - Street 1:1093 BEACON STREET
Practice Address - Street 2:SUITE 4A
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-731-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04190OtherBCBS