Provider Demographics
NPI:1003620378
Name:GROSS, BOJENA D (CT)
Entity type:Individual
Prefix:
First Name:BOJENA
Middle Name:D
Last Name:GROSS
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4119
Mailing Address - Country:US
Mailing Address - Phone:304-972-9428
Mailing Address - Fax:
Practice Address - Street 1:9150 MARKET SQUARE DR STE 201
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4573
Practice Address - Country:US
Practice Address - Phone:330-422-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406401-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor