Provider Demographics
NPI:1780758490
Name:GROSSMAN, MEG (LISW)
Entity type:Individual
Prefix:
First Name:MEG
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 RIVER RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9584
Mailing Address - Country:US
Mailing Address - Phone:740-587-1720
Mailing Address - Fax:
Practice Address - Street 1:935 RIVER RD
Practice Address - Street 2:SUITE I
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9584
Practice Address - Country:US
Practice Address - Phone:740-587-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0005215104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0005215OtherSOCIAL WORKER LICENSE