Provider Demographics
NPI:1467662817
Name:GROSS, MARGO RUTH (EDD, LMFT, OTR)
Entity Type:Individual
Prefix:DR
First Name:MARGO
Middle Name:RUTH
Last Name:GROSS
Suffix:
Gender:F
Credentials:EDD, LMFT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 POVERTY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-3005
Mailing Address - Country:US
Mailing Address - Phone:203-938-2308
Mailing Address - Fax:203-938-2308
Practice Address - Street 1:15 POVERTY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CT
Practice Address - Zip Code:06896-3005
Practice Address - Country:US
Practice Address - Phone:203-938-2308
Practice Address - Fax:203-938-2308
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist