Provider Demographics
NPI:1770066565
Name:GROSS, ELLEN (MMT, MT-BC)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:MMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HOLIDAY DRIVE
Mailing Address - Street 2:SUIE 110, FOSTER PLAZA #9
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220
Mailing Address - Country:US
Mailing Address - Phone:412-328-8845
Mailing Address - Fax:
Practice Address - Street 1:750 HOLIDAY DRIVE
Practice Address - Street 2:SUIE 110, FOSTER PLAZA #9
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220
Practice Address - Country:US
Practice Address - Phone:412-328-8845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-08
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA08707225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty