Provider Demographics
NPI:1285750083
Name:GROSSMAN, SETH DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:DAVID
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 N UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5047
Mailing Address - Country:US
Mailing Address - Phone:954-434-1886
Mailing Address - Fax:954-699-0337
Practice Address - Street 1:2929 N. UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5047
Practice Address - Country:US
Practice Address - Phone:954-434-1886
Practice Address - Fax:954-699-0337
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7340103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75511OtherBLUE CROSS BLUE SHIELD
FLAY654Medicare UPIN