Provider Demographics
NPI:1184756264
Name:GROSS, ROBERT (MFT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855-F ALAMO ST.
Mailing Address - Street 2:SUITE 2032
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063
Mailing Address - Country:US
Mailing Address - Phone:805-582-7507
Mailing Address - Fax:805-582-7514
Practice Address - Street 1:3855-F ALAMO ST.
Practice Address - Street 2:SUITE 2032
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063
Practice Address - Country:US
Practice Address - Phone:805-582-7507
Practice Address - Fax:805-582-7514
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36312106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist