Provider Demographics
NPI:1487788667
Name:GROSSMAN, MEREDITH (PHD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:GROSSMAN
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 1:400 CENTRAL PARK W APT 14B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5844
Mailing Address - Country:US
Mailing Address - Phone:212-300-4992
Mailing Address - Fax:
Practice Address - Street 1:525 E. 68TH ST., BOX 140
Practice Address - Street 2:C/O WEILL CORNELL MEDICAL COLLEGE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-746-5931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 019118103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist