Provider Demographics
NPI:1396952511
Name:GROSS, CONSTANCE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:ANN
Last Name:GROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 ENTERPRISE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763
Mailing Address - Country:US
Mailing Address - Phone:727-791-9312
Mailing Address - Fax:
Practice Address - Street 1:2424 ENTERPRISE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763
Practice Address - Country:US
Practice Address - Phone:727-791-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5772103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent