Provider Demographics
NPI:1174763916
Name:GROSS, AMBER (LCPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MAINE ST STE 6
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2071
Mailing Address - Country:US
Mailing Address - Phone:207-504-7892
Mailing Address - Fax:
Practice Address - Street 1:136 MAINE ST STE 6
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2071
Practice Address - Country:US
Practice Address - Phone:207-504-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health