Provider Demographics
NPI:1245601764
Name:GROSS, BRUCE ROBERT (MSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ROBERT
Last Name:GROSS
Suffix:
Gender:M
Credentials:MSW
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Mailing Address - Street 1:6244 EL CAJON BLVD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3918
Mailing Address - Country:US
Mailing Address - Phone:619-287-8225
Mailing Address - Fax:619-287-4146
Practice Address - Street 1:6244 EL CAJON BLVD
Practice Address - Street 2:15
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3918
Practice Address - Country:US
Practice Address - Phone:619-287-8225
Practice Address - Fax:619-287-4146
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)