Provider Demographics
NPI:1922217942
Name:ERWIN-GROTSKY, JAY MARCUS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:MARCUS
Last Name:ERWIN-GROTSKY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR
Mailing Address - Street 2:SUITE 900
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6900
Mailing Address - Country:US
Mailing Address - Phone:512-732-7272
Mailing Address - Fax:512-732-2012
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:SUITE 900
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-732-7272
Practice Address - Fax:512-732-2012
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical