| Doctor Name: | IVY B GROSS |
| NPI Number: | 1003247305 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 217349 |
| Business Practice Address: | 615 Leominster Rd Lunenburg, MA - 014622013 |
| Business Phone Number: | 9785827103 |
| Business Fax Number: | |
| Mailing Address: | 43 Jackson Rd, SOMERVILLE |
| State: | MA |
| Postal Code: | 021452908 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/12/2013 |
| NPI Last Update Date: | 09/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 217349 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |