Provider Demographics
NPI:1609174457
Name:GROSSMAN, RUTH LEILA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:LEILA
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:RUTH
Other - Middle Name:LEILA
Other - Last Name:HARNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1829 EAST SANDERLING LANE
Mailing Address - Street 2:
Mailing Address - City:FT. PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982
Mailing Address - Country:US
Mailing Address - Phone:772-924-2992
Mailing Address - Fax:
Practice Address - Street 1:1829 E SANDERLING LN
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8046
Practice Address - Country:US
Practice Address - Phone:772-924-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5938101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor