Provider Demographics
NPI:1558572537
Name:GROTH, WILLIAM (CSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:GROTH
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:GROTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW
Mailing Address - Street 1:117 W 13TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7832
Mailing Address - Country:US
Mailing Address - Phone:212-696-8648
Mailing Address - Fax:
Practice Address - Street 1:117 W 13TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7832
Practice Address - Country:US
Practice Address - Phone:212-696-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052993-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical