Provider Demographics
NPI:1982916102
Name:GROSS, MARJORIE HOPE (AAS, CP,)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:HOPE
Last Name:GROSS
Suffix:
Gender:F
Credentials:AAS, CP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRILLIUM LN
Mailing Address - Street 2:ALBANY LIFEWORKS CENTER
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3818
Mailing Address - Country:US
Mailing Address - Phone:518-862-1974
Mailing Address - Fax:
Practice Address - Street 1:200 TRILLIUM LN
Practice Address - Street 2:ALBANY LIFEWORKS CENTER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3818
Practice Address - Country:US
Practice Address - Phone:518-862-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health