Provider Demographics
NPI:1811198906
Name:GROSSO, GEORGE JOSEPH (PHD PSYCH)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:GROSSO
Suffix:
Gender:M
Credentials:PHD PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 SORREL COURT
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561
Mailing Address - Country:US
Mailing Address - Phone:661-822-9011
Mailing Address - Fax:661-822-0476
Practice Address - Street 1:24100 SORREL COURT
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561
Practice Address - Country:US
Practice Address - Phone:661-822-9011
Practice Address - Fax:661-822-0476
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10108103G00000X, 103TC0700X, 103TF0200X
103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)