Provider Demographics
NPI:1902102403
Name:CAROL L. GROSS, LCSW, LLC
Entity Type:Organization
Organization Name:CAROL L. GROSS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-592-0329
Mailing Address - Street 1:8705 NW 29TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5328
Mailing Address - Country:US
Mailing Address - Phone:954-344-9643
Mailing Address - Fax:
Practice Address - Street 1:5551 N UNIVERSITY DR
Practice Address - Street 2:#202
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4651
Practice Address - Country:US
Practice Address - Phone:954-592-0329
Practice Address - Fax:954-796-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW44871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9747YMedicare PIN