Provider Demographics
NPI:1487634895
Name:GROSSMAN, ROBIN MARLENE (LCSW LMFT)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:MARLENE
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3356 SECOND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-237-7333
Mailing Address - Fax:619-298-1478
Practice Address - Street 1:3356 SECOND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-237-7333
Practice Address - Fax:619-298-1478
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS15404104100000X
CAMFC25527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ309672OtherBLUE SHIELD
CACSW154040Medicaid
CA049901OtherMANAGED HEALTH NETWORK
CAZZZ309672OtherBLUE SHIELD