Provider Demographics
NPI:1043646995
Name:GROSS, DEBBIE (LCSW-R)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BROADWAY STE D2
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2731
Mailing Address - Country:US
Mailing Address - Phone:516-721-6212
Mailing Address - Fax:631-828-8216
Practice Address - Street 1:4 OTTER PATH
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2148
Practice Address - Country:US
Practice Address - Phone:516-764-5522
Practice Address - Fax:516-764-0154
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076337-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical