Provider Demographics
NPI:1871705608
Name:GROSS, PAMELA S (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:GROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7326 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-9668
Mailing Address - Country:US
Mailing Address - Phone:716-326-6735
Mailing Address - Fax:716-736-6226
Practice Address - Street 1:12 N STATE ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:NY
Practice Address - Zip Code:14775-9762
Practice Address - Country:US
Practice Address - Phone:716-736-2631
Practice Address - Fax:716-736-6226
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072800-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical