Provider Demographics
NPI:1144656273
Name:GROSS, STEPHEN J
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:GROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3502
Mailing Address - Country:US
Mailing Address - Phone:516-647-5154
Mailing Address - Fax:516-271-3137
Practice Address - Street 1:74 NEW YORK AVE STE 2
Practice Address - Street 2:
Practice Address - City:HALESITE
Practice Address - State:NY
Practice Address - Zip Code:11743-2173
Practice Address - Country:US
Practice Address - Phone:516-647-5154
Practice Address - Fax:516-271-3137
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091597-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical