Provider Demographics
NPI:1740573799
Name:GROSSMAN, SHAWNA (LPC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 EDGEMERE RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2828
Mailing Address - Country:US
Mailing Address - Phone:201-341-4147
Mailing Address - Fax:
Practice Address - Street 1:685 BLOOMFIELD AVE
Practice Address - Street 2:STE 201
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1630
Practice Address - Country:US
Practice Address - Phone:973-239-0948
Practice Address - Fax:973-239-0972
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00413700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health