Provider Demographics
NPI:1952469223
Name:GROESSBRINK, KATHLEEN RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RUTH
Last Name:GROESSBRINK
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 1:9 WAYLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044
Mailing Address - Country:US
Mailing Address - Phone:973-239-4905
Mailing Address - Fax:973-239-8968
Practice Address - Street 1:1140 BLOOMFIELD AVENUE
Practice Address - Street 2:SUITE 212
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006
Practice Address - Country:US
Practice Address - Phone:973-239-4905
Practice Address - Fax:973-239-8968
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC 13900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker