Provider Demographics
NPI:1477914489
Name:GROSSMAN, BRIAN (LMSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1204
Mailing Address - Country:US
Mailing Address - Phone:585-267-9782
Mailing Address - Fax:
Practice Address - Street 1:14 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1204
Practice Address - Country:US
Practice Address - Phone:585-267-9782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094715104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker