Provider Demographics
NPI:1306033691
Name:GROSS, CARLA S (LSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:S
Last Name:GROSS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 N DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9456
Mailing Address - Country:US
Mailing Address - Phone:937-440-7001
Mailing Address - Fax:
Practice Address - Street 1:3130 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-9456
Practice Address - Country:US
Practice Address - Phone:937-440-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0015694104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker