Provider Demographics
NPI:1275963852
Name:SUSAN GROSS PSYD PLLC
Entity Type:Organization
Organization Name:SUSAN GROSS PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-721-4716
Mailing Address - Street 1:451 S ETON ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6524
Mailing Address - Country:US
Mailing Address - Phone:248-721-4716
Mailing Address - Fax:734-207-5326
Practice Address - Street 1:451 S ETON ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6524
Practice Address - Country:US
Practice Address - Phone:248-721-4716
Practice Address - Fax:734-207-5326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE16510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty