Provider Demographics
NPI:1073676219
Name:GROSSMAN, MARC (LCSW)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W END AVE
Mailing Address - Street 2:SUITE 1N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5601
Mailing Address - Country:US
Mailing Address - Phone:212-362-1086
Mailing Address - Fax:212-877-9204
Practice Address - Street 1:160 W END AVE
Practice Address - Street 2:SUITE 1N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5601
Practice Address - Country:US
Practice Address - Phone:212-362-1086
Practice Address - Fax:212-877-9204
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0431961041C0700X
NJ44SC047010001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNG3121Medicare ID - Type Unspecified