Provider Demographics
NPI:1679043178
Name:GROSSMAN, REBECCA (CADC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 WESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-3454
Mailing Address - Country:US
Mailing Address - Phone:908-442-6909
Mailing Address - Fax:
Practice Address - Street 1:198 WESCOTT RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-3454
Practice Address - Country:US
Practice Address - Phone:908-442-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00139000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37CA00139000OtherCADC