Provider Demographics
NPI:1437323953
Name:GROSE, RICHARD B (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:GROSE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 97TH ST
Mailing Address - Street 2:ROOM 104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10125-0001
Mailing Address - Country:US
Mailing Address - Phone:347-853-1279
Mailing Address - Fax:
Practice Address - Street 1:140 W 97TH ST
Practice Address - Street 2:ROOM 104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10125-0001
Practice Address - Country:US
Practice Address - Phone:347-853-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000310-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst