Provider Demographics
NPI:1649319872
Name:GROSSMAN, SONDRA (MSW-LCSW)
Entity type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MSW-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23471 RIBALTA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1339
Mailing Address - Country:US
Mailing Address - Phone:949-215-9140
Mailing Address - Fax:949-215-7798
Practice Address - Street 1:25283 CABOT RD
Practice Address - Street 2:107
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5522
Practice Address - Country:US
Practice Address - Phone:949-215-9140
Practice Address - Fax:949-215-7798
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 167401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS07197Medicare UPIN
CASW 16740Medicare ID - Type Unspecified