Provider Demographics
NPI:1225051972
Name:GROSSO, GERALD JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JOSEPH
Last Name:GROSSO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20371 IRVINE AVE
Mailing Address - Street 2:#A106
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5651
Mailing Address - Country:US
Mailing Address - Phone:949-722-1146
Mailing Address - Fax:
Practice Address - Street 1:20371 IRVINE AVE
Practice Address - Street 2:#A106
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5651
Practice Address - Country:US
Practice Address - Phone:949-722-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist