Provider Demographics
NPI:1629703996
Name:GROSS, JILLIAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DAMIANO PL
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6503
Mailing Address - Country:US
Mailing Address - Phone:315-404-5315
Mailing Address - Fax:
Practice Address - Street 1:8469 SENECA TPKE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-4902
Practice Address - Country:US
Practice Address - Phone:315-404-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker