NPIMap

Organization Active NPI

Pamela B. Grossman, PH.D.

  • Clinical Child & Adolescent Psychologist
  • Bryan, TX
National Provider Identifier
1649447053
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
25064 Issued in TX
Legal business name
PAMELA B. GROSSMAN, PH.D.
Practice address
3201 University Dr E
Suite 200
Bryan, TX 77802-3475
Phone
(979) 268-7776
Fax
(979) 268-8618
NPI assigned
May 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Authorized official

Name
Dr. Pamela B. Grossman, PH.D.
Title
Owner/Psychologist
Phone
(979) 268-7776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC2200X 25064 TX Primary

Addresses

Primary practice location

3201 University Dr E
Suite 200
Bryan, TX 77802-3475

Mailing address

3201 University Dr E
Suite 200
Bryan, TX 77802-3475
Phone (979) 268-7776

Other identifiers 5

IdentifierTypeStateIssuer
0031JKOtherTXBC/BS
86740AOtherTXBC/BS
036303801MedicaidTX
152784801MedicaidTX
U41FOtherTXBC/BS

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1649447053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 UNIVERSITY DR E",
            "address_2": "SUITE 200",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023475",
            "telephone_number": "979-268-7776",
            "fax_number": "979-268-8618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 UNIVERSITY DR E",
            "address_2": "SUITE 200",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023475",
            "telephone_number": "979-268-7776",
            "fax_number": "979-268-8618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAMELA B. GROSSMAN, PH.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "GROSSMAN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "979-268-7776",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "TX",
            "license": "25064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "0031JK",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "86740A",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036303801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152784801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "U41F",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.