Provider Demographics
NPI:1184606568
Name:GROSSMAN, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2545
Mailing Address - Country:US
Mailing Address - Phone:978-664-6347
Mailing Address - Fax:
Practice Address - Street 1:67 LEONARD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2523
Practice Address - Country:US
Practice Address - Phone:617-484-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical