Provider Demographics
NPI:1134270630
Name:GROSSMAN, ARLENE B (MSW)
Entity type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:B
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1650
Mailing Address - Country:US
Mailing Address - Phone:212-860-0296
Mailing Address - Fax:
Practice Address - Street 1:165 E 89TH ST
Practice Address - Street 2:APT. I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2315
Practice Address - Country:US
Practice Address - Phone:212-860-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO15342-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144128OtherVALUE OPTIONS ID