Provider Demographics
NPI:1467049080
Name:GROSVENOR, LOIS (PHD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:GROSVENOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 ROUTE 34 FL 2
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-6612
Mailing Address - Country:US
Mailing Address - Phone:732-858-4030
Mailing Address - Fax:
Practice Address - Street 1:721 ROUTE 34, 2ND FL
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-6612
Practice Address - Country:US
Practice Address - Phone:732-858-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral