Provider Demographics
NPI:1700369543
Name:GROSS, MICHELE LILLY
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LILLY
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PORTSMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3827
Mailing Address - Country:US
Mailing Address - Phone:413-530-2732
Mailing Address - Fax:
Practice Address - Street 1:15 LOBAO DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1199
Practice Address - Country:US
Practice Address - Phone:978-774-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1194791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical