Provider Demographics
NPI:1689780694
Name:GROSSMAN, GENE JOSEPH (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:JOSEPH
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2507
Mailing Address - Country:US
Mailing Address - Phone:510-531-9525
Mailing Address - Fax:510-531-9525
Practice Address - Street 1:2881 CHELSEA DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2507
Practice Address - Country:US
Practice Address - Phone:510-995-7699
Practice Address - Fax:510-531-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT6276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist