Provider Demographics
NPI:1477884716
Name:DEBRA B GROSS LCSW P A
Entity Type:Organization
Organization Name:DEBRA B GROSS LCSW P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-258-5216
Mailing Address - Street 1:12354 NW 26TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-8005
Mailing Address - Country:US
Mailing Address - Phone:954-258-5216
Mailing Address - Fax:954-345-4047
Practice Address - Street 1:8333 W MCNAB RD
Practice Address - Street 2:SUITE 131
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3242
Practice Address - Country:US
Practice Address - Phone:954-258-5216
Practice Address - Fax:954-345-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty