Individual
MR. JON BIRDELL GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.W.
Contact information
Practice address
1300 N 12TH ST STE 550, PHOENIX, AZ 85006-2820
(602) 410-6637
(480) 609-9552
Mailing address
5929 E CHARTER OAK RD, SCOTTSDALE, AZ 85254-4348
(602) 410-6637
(480) 609-9552
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW0754
AZ
106H00000X
Marriage & Family Therapist
LMFT0182
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
964579
AHCCS PROVIDER ID
AZ
Enumeration date
01/19/2007
Last updated
11/30/2023
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