Provider Demographics
NPI:1417016254
Name:GROSS, DEBORAH A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:GROSS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E VAN BUREN ST
Mailing Address - Street 2:MTU ASPC PHOENIX
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6037
Mailing Address - Country:US
Mailing Address - Phone:602-685-3100
Mailing Address - Fax:
Practice Address - Street 1:2500 E VAN BUREN ST
Practice Address - Street 2:MTU ASPC PHOENIX
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6037
Practice Address - Country:US
Practice Address - Phone:602-685-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical