Dr. Mike Gross, LLC

Primary specialty

Exercise & Sports PsychologistTaxonomy code 103TE1100X

License

35SI00577700 Issued in NJ

Legal business name

DR. MIKE GROSS, LLC

Doing business as

TriState SportPsych

Practice address

30 Chatham Road #803
Short Hills, NJ 07078-0707

Phone

(908) 913-0637

NPI assigned

Jul 31, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mike Gross, PSYD, LPC, CMPC

Title

Licensed Psychologist

Phone

(908) 913-0637

Specialties & licenses 3

Addresses

Other names 1

• TriState SportPsych Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Brian Gross, PSYD, LPC, CMPC

  • Exercise & Sports Psychologist
  • Short Hills, NJ
  • NPI 1932472990

  Cognitive & Behavioral

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629936000000",
    "number": "1386122489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CHATHAM ROAD #803",
            "city": "SHORT HILLS",
            "state": "NJ",
            "postal_code": "070785039",
            "telephone_number": "908-913-0637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CHATHAM ROAD #803",
            "city": "SHORT HILLS",
            "state": "NJ",
            "postal_code": "070780707",
            "telephone_number": "908-913-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MIKE GROSS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-31",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "908-913-0637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LPC, CMPC"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NJ",
            "license": "35SI00577700",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00577700",
            "primary": false
        },
        {
            "code": "103TE1100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Exercise & Sports",
            "state": "NJ",
            "license": "35SI00577700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TriState SportPsych",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychologist in Short Hills, NJ
• Providers in Short Hills, NJ by specialty
• Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.