Provider Demographics
NPI:1851731418
Name:GROSSMAN, BARRY I (MS)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:I
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 NATHANIEL TRL
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18974-6147
Mailing Address - Country:US
Mailing Address - Phone:215-272-2193
Mailing Address - Fax:
Practice Address - Street 1:931 NATHANIEL TRL
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:PA
Practice Address - Zip Code:18974-6147
Practice Address - Country:US
Practice Address - Phone:215-272-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002834L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist