Provider Demographics
NPI:1598785685
Name:GROSSMAN, WILLIAM S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:390 1ST AVE APT 11F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4935
Mailing Address - Country:US
Mailing Address - Phone:212-260-4375
Mailing Address - Fax:
Practice Address - Street 1:845 N BROADWAY
Practice Address - Street 2:WJCS
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-2403
Practice Address - Country:US
Practice Address - Phone:914-761-0600
Practice Address - Fax:914-761-5367
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0142391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY198580OtherHEALTHNET
NYN31131Medicare PIN