Provider Demographics
NPI:1407191000
Name:GROSSMAN, MARNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3035
Mailing Address - Country:US
Mailing Address - Phone:973-746-6733
Mailing Address - Fax:
Practice Address - Street 1:318 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1181
Practice Address - Country:US
Practice Address - Phone:973-919-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05800200104100000X
NJ44SC05620801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker