Provider Demographics
NPI:1942400577
Name:GROSSMAN, AVRAHAM A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:AVRAHAM
Middle Name:A
Last Name:GROSSMAN
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 1:7502 FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5404
Mailing Address - Country:US
Mailing Address - Phone:729-502-4146
Mailing Address - Fax:
Practice Address - Street 1:7502 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5404
Practice Address - Country:US
Practice Address - Phone:729-502-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical