Provider Demographics
NPI:1407063670
Name:GROSS, NORMAN CHARLES (SOCIAL WORKER LICSW)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:CHARLES
Last Name:GROSS
Suffix:
Gender:M
Credentials:SOCIAL WORKER LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SEMINOLE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067
Mailing Address - Country:US
Mailing Address - Phone:781-793-0237
Mailing Address - Fax:781-784-2018
Practice Address - Street 1:5 SEMINOLE CIRCLE
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067
Practice Address - Country:US
Practice Address - Phone:781-793-0237
Practice Address - Fax:781-784-2018
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10564611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGRP03662OtherBCBS
P20330Medicare ID - Type Unspecified