Provider Demographics
NPI:1801818117
Name:GROSS, ELLEN J (MSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:GROSS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 4TH AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-2108
Mailing Address - Country:US
Mailing Address - Phone:412-456-7566
Mailing Address - Fax:412-391-6640
Practice Address - Street 1:307 4TH AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2108
Practice Address - Country:US
Practice Address - Phone:412-456-7566
Practice Address - Fax:412-391-6640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0122171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA634071OtherBLUE CROSS