Provider Demographics
NPI:1558412924
Name:GROSSCUP, MARY ELIZABETH (MA LP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:GROSSCUP
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Gender:F
Credentials:MA LP
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Mailing Address - Street 1:11953 BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8860
Mailing Address - Country:US
Mailing Address - Phone:952-259-1351
Mailing Address - Fax:952-925-5972
Practice Address - Street 1:5353 GAMBLE DR STE 395
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1510
Practice Address - Country:US
Practice Address - Phone:952-259-1351
Practice Address - Fax:952-925-5972
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MN3335103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist