Provider Demographics
NPI:1699850107
Name:GROSSKURTH, MICHELE RHEA (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RHEA
Last Name:GROSSKURTH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:RHEA
Other - Last Name:GROSSKURTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:22 ROLLING HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2065
Mailing Address - Country:US
Mailing Address - Phone:631-724-2744
Mailing Address - Fax:
Practice Address - Street 1:22 ROLLING HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2065
Practice Address - Country:US
Practice Address - Phone:631-724-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP027576-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical