Provider Demographics
NPI:1902353253
Name:GRASSO, GERARDO JR (LSW)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:GRASSO
Suffix:JR
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 BUNKER DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-5327
Mailing Address - Country:US
Mailing Address - Phone:609-214-4462
Mailing Address - Fax:
Practice Address - Street 1:9956 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1077
Practice Address - Country:US
Practice Address - Phone:667-288-1566
Practice Address - Fax:410-429-1399
Is Sole Proprietor?:No
Enumeration Date:2016-09-03
Last Update Date:2022-11-15
Deactivation Date:2018-04-02
Deactivation Code:
Reactivation Date:2022-11-15
Provider Licenses
StateLicense IDTaxonomies
PASW132696104100000X
NJ44SL06052800104100000X
MD29312104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker