Provider Demographics
NPI:1871293720
Name:GROSS, NICOLAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 NE 18TH TER
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3114
Mailing Address - Country:US
Mailing Address - Phone:305-343-2067
Mailing Address - Fax:
Practice Address - Street 1:5230 NE 18TH TER
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3114
Practice Address - Country:US
Practice Address - Phone:305-343-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW70081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical