Provider Demographics
NPI:1851562334
Name:GROSSMARK, CARINA LILIA (PHD IN CLINICAL PSYC)
Entity Type:Individual
Prefix:DR
First Name:CARINA
Middle Name:LILIA
Last Name:GROSSMARK
Suffix:
Gender:F
Credentials:PHD IN CLINICAL PSYC
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Mailing Address - Street 1:3424 KOSSUTH AVENUE
Mailing Address - Street 2:OPD CLINIC 4B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-519-3556
Mailing Address - Fax:718-519-2497
Practice Address - Street 1:3424 KOSSUTH AVENUE
Practice Address - Street 2:OPD CLINIC 4B PSYCHIATRY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-519-3556
Practice Address - Fax:718-519-2497
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical