Provider Demographics
NPI:1821114620
Name:GROSS, ELIZABETH SUSAN (MSW,LSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:GROSS
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 CHESTNUT ST
Mailing Address - Street 2:UNIT 1506
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3401
Mailing Address - Country:US
Mailing Address - Phone:215-569-4276
Mailing Address - Fax:215-568-0769
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123770104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker