Provider Demographics
NPI:1437327848
Name:GROSSBERG, JILL KAREN (MSS, LSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:KAREN
Last Name:GROSSBERG
Suffix:
Gender:F
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 NORTHEAST AVE
Mailing Address - Street 2:APT 12
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3746
Mailing Address - Country:US
Mailing Address - Phone:215-552-9569
Mailing Address - Fax:
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:RM 821
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW011251L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker