Provider Demographics
NPI:1417153891
Name:GROSS, KARA (LCSW)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:GROSS
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 1:2911 BRUNSWICK RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4105
Mailing Address - Country:US
Mailing Address - Phone:901-373-0935
Mailing Address - Fax:901-373-0984
Practice Address - Street 1:2911 BRUNSWICK RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4105
Practice Address - Country:US
Practice Address - Phone:901-373-0935
Practice Address - Fax:901-373-0984
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2014-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW00000065941041C0700X
TN50581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical