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Individual

MOLLY C GROSSMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
1700 EDUCATION AVE, PUNTA GORDA, FL 33950
(941) 639-8300
(941) 639-6831
Mailing address
708 EAGLE POINT DR, VENICE, FL 34285
(941) 486-1628

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
PY7456
FL
103TC0700X
Clinical Psychologist
4722
OH
103TC0700X
Clinical Psychologist
Primary
PY7456
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
768242500
FL
Enumeration date
09/30/2005
Last updated
09/29/2009
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