Provider Demographics
NPI:1942217658
Name:GROSS, DEBRA B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:B
Last Name:GROSS
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 1:12354 NW 26TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-8005
Mailing Address - Country:US
Mailing Address - Phone:954-258-5216
Mailing Address - Fax:954-345-4047
Practice Address - Street 1:8333 W MCNAB RD
Practice Address - Street 2:SUITE 131
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3242
Practice Address - Country:US
Practice Address - Phone:954-258-5216
Practice Address - Fax:954-345-4047
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW18021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3334Medicare ID - Type Unspecified