Provider Demographics
NPI:1932251337
Name:GROSSMAN, ERIK SETH (LMP)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:SETH
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 FREMONT AVE N APT E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8746
Mailing Address - Country:US
Mailing Address - Phone:206-380-9047
Mailing Address - Fax:
Practice Address - Street 1:5211 20TH AVE NW STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4001
Practice Address - Country:US
Practice Address - Phone:206-297-2792
Practice Address - Fax:206-297-1051
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00056511101YP2500X
WAMA 60404008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional