Provider Demographics
NPI:1093203440
Name:GROZA, VICTOR K (LISW-S, PHD)
Entity Type:Individual
Prefix:PROF
First Name:VICTOR
Middle Name:K
Last Name:GROZA
Suffix:
Gender:M
Credentials:LISW-S, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2021
Mailing Address - Country:US
Mailing Address - Phone:216-392-5798
Mailing Address - Fax:
Practice Address - Street 1:856 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2021
Practice Address - Country:US
Practice Address - Phone:216-392-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0005193-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical