Provider Demographics
NPI:1720322308
Name:GROSSMAN, GERALD LESLIE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LESLIE
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 8TH AVE
Mailing Address - Street 2:APT 64
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3560
Mailing Address - Country:US
Mailing Address - Phone:347-853-3180
Mailing Address - Fax:
Practice Address - Street 1:401 8TH AVE
Practice Address - Street 2:APT 64
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3560
Practice Address - Country:US
Practice Address - Phone:347-853-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035160-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical