Healthcare Provider Details

I. General information

NPI: 1295485449
Provider Name (Legal Business Name): JENNIFER ROSE GRILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 W COLONIAL DR STE 340
WINTER GARDEN FL
34787-3977
US

IV. Provider business mailing address

13350 W COLONIAL DR STE 340
WINTER GARDEN FL
34787-3977
US

V. Phone/Fax

Practice location:
  • Phone: 352-697-1707
  • Fax:
Mailing address:
  • Phone: 352-697-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW19747
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: