Provider Demographics
NPI:1104910751
Name:GROSSMAN-MCKEE, DOUGLAS (PHD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:GROSSMAN-MCKEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 WILSON MILLS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2128
Mailing Address - Country:US
Mailing Address - Phone:216-650-4928
Mailing Address - Fax:877-689-9547
Practice Address - Street 1:6151 WILSON MILLS RD STE 200
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2128
Practice Address - Country:US
Practice Address - Phone:216-650-4928
Practice Address - Fax:877-689-9547
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4146103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP29701Medicare ID - Type Unspecified