Provider Demographics
NPI:1669870200
Name:GROSS, ARIELLA
Entity type:Individual
Prefix:
First Name:ARIELLA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARIELLA
Other - Middle Name:
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LGSW
Mailing Address - Street 1:6502 WICKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6502 WICKFIELD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2530
Practice Address - Country:US
Practice Address - Phone:516-547-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17632104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker