Provider Demographics
NPI:1871673509
Name:GROSSMAN, FREDERICK DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:DANIEL
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NW 12TH AVE APT 614
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2860
Mailing Address - Country:US
Mailing Address - Phone:503-505-7227
Mailing Address - Fax:503-564-0739
Practice Address - Street 1:1130 NW 12TH AVE APT 614
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2860
Practice Address - Country:US
Practice Address - Phone:503-505-7227
Practice Address - Fax:503-564-0739
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPSY00897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical