Provider Demographics
NPI:1922272780
Name:GROSS, RUSSELL ELROY JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ELROY
Last Name:GROSS
Suffix:JR
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 1:2923 W ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4703
Mailing Address - Country:US
Mailing Address - Phone:610-248-4891
Mailing Address - Fax:
Practice Address - Street 1:2923 W ALLEN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4703
Practice Address - Country:US
Practice Address - Phone:610-248-4891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005980L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling