Provider Demographics
NPI:1437462173
Name:GROSSMAYER, MADELEINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:GROSSMAYER
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 1:12161 KEN ADAMS WAY
Mailing Address - Street 2:SUITE 154
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3194
Mailing Address - Country:US
Mailing Address - Phone:561-247-5833
Mailing Address - Fax:
Practice Address - Street 1:12161 KEN ADAMS WAY
Practice Address - Street 2:SUITE 154
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3194
Practice Address - Country:US
Practice Address - Phone:561-247-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW137001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical