Provider Demographics
NPI:1679508329
Name:GROSSMAN, DELLA S (EDD)
Entity Type:Individual
Prefix:DR
First Name:DELLA
Middle Name:S
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1751
Mailing Address - Country:US
Mailing Address - Phone:610-668-6727
Mailing Address - Fax:610-667-2256
Practice Address - Street 1:1216 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1751
Practice Address - Country:US
Practice Address - Phone:610-668-6727
Practice Address - Fax:610-667-2256
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 002196-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist