Provider Demographics
NPI:1336383678
Name:GROSS, SHELENE M (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:SHELENE
Middle Name:M
Last Name:GROSS
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:SHELENE
Other - Middle Name:
Other - Last Name:SEUFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 ETHEL RD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2838
Mailing Address - Country:US
Mailing Address - Phone:732-248-1805
Mailing Address - Fax:732-248-1809
Practice Address - Street 1:1 ETHEL RD
Practice Address - Street 2:SUITE 101B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2838
Practice Address - Country:US
Practice Address - Phone:732-248-1805
Practice Address - Fax:732-248-1809
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054645001041C0700X
NJ37LC00173800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)