Provider Demographics
NPI:1548858848
Name:GROSSMAN, LISSA ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISSA
Middle Name:ANN
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SUNRISE HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2113
Mailing Address - Country:US
Mailing Address - Phone:917-658-9589
Mailing Address - Fax:
Practice Address - Street 1:77 SUNRISE HILL RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2113
Practice Address - Country:US
Practice Address - Phone:917-658-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17214101YA0400X
NY075300-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22553412Medicaid