Provider Demographics
NPI:1710082417
Name:GROSS, CAROL L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:GROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 NW 29TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5328
Mailing Address - Country:US
Mailing Address - Phone:954-592-0329
Mailing Address - Fax:
Practice Address - Street 1:5551 N UNIVERSITY DR STE 202
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4651
Practice Address - Country:US
Practice Address - Phone:954-592-0329
Practice Address - Fax:954-796-1070
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW44871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9747XMedicare UPIN