Provider Demographics
NPI:1871748061
Name:GROSS, MARTHA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 HARRISON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1926
Mailing Address - Country:US
Mailing Address - Phone:202-364-8555
Mailing Address - Fax:202-364-8556
Practice Address - Street 1:4600 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE223
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-5750
Practice Address - Country:US
Practice Address - Phone:202-364-8555
Practice Address - Fax:202-364-8556
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1809103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist