Provider Demographics
NPI:1811209000
Name:GROSS, NATALIE R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:R
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 1:24 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1423
Mailing Address - Country:US
Mailing Address - Phone:516-770-6043
Mailing Address - Fax:
Practice Address - Street 1:156 BEACH 9TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5636
Practice Address - Country:US
Practice Address - Phone:516-770-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075194103K00000X, 103K00000X
NY087925-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY087925-1OtherREGISTRATION CERTIFICATE