Provider Demographics
NPI:1851750590
Name:GROSSO, COLETTE ALEXIS (LCSW)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:ALEXIS
Last Name:GROSSO
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 1:1518 WALNUT ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:267-712-9622
Mailing Address - Fax:486-352-3659
Practice Address - Street 1:1518 WALNUT ST
Practice Address - Street 2:SUITE 900
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:267-712-9622
Practice Address - Fax:486-352-3659
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW184691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical