Provider Demographics
NPI:1497804652
Name:GROSSMAN, LAURA E (ACSW LCSW CASAC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:ACSW LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WREN LANE
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2727
Mailing Address - Country:US
Mailing Address - Phone:631-696-1328
Mailing Address - Fax:631-289-0499
Practice Address - Street 1:11 WREN LANE
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2727
Practice Address - Country:US
Practice Address - Phone:631-696-1328
Practice Address - Fax:631-289-0499
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0317881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical