Provider Demographics
NPI:1063741833
Name:GROSS, ELISSA R (PSYD)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:R
Last Name:GROSS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 UNION AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2141
Mailing Address - Country:US
Mailing Address - Phone:201-403-1284
Mailing Address - Fax:
Practice Address - Street 1:300 KNICKERBOCKER ROAD, SUITE 3200
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1346
Practice Address - Country:US
Practice Address - Phone:201-871-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00387300103TC0700X
NY013760-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical