Provider Demographics
NPI:1043805948
Name:GROSSMAN, MAHESHWARA (CCHT)
Entity Type:Individual
Prefix:
First Name:MAHESHWARA
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 SAND DOLLAR DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-7484
Mailing Address - Country:US
Mailing Address - Phone:510-323-5962
Mailing Address - Fax:
Practice Address - Street 1:2145 SAND DOLLAR DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-7484
Practice Address - Country:US
Practice Address - Phone:510-323-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional