Provider Demographics
NPI:1174880959
Name:GROSS, JONATHAN DREW (PSYD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DREW
Last Name:GROSS
Suffix:
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:9310 OLD KINGS RD S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6152
Mailing Address - Country:US
Mailing Address - Phone:904-437-5176
Mailing Address - Fax:904-438-3175
Practice Address - Street 1:9310 OLD KINGS RD S
Practice Address - Street 2:SUITE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6152
Practice Address - Country:US
Practice Address - Phone:904-437-5176
Practice Address - Fax:904-438-3175
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2013-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPY 8505103G00000X, 103TC0700X
GAPSY003602103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical