Provider Demographics
NPI:1043631344
Name:GROSSMAN-ORR, MAREIDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAREIDA
Middle Name:
Last Name:GROSSMAN-ORR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GARRETT ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-3413
Mailing Address - Country:US
Mailing Address - Phone:336-772-3392
Mailing Address - Fax:866-404-5622
Practice Address - Street 1:201 N EUGENE ST
Practice Address - Street 2:MONARCH
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2221
Practice Address - Country:US
Practice Address - Phone:336-676-6840
Practice Address - Fax:866-404-5622
Is Sole Proprietor?:No
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0071731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical