Healthcare Provider Details

I. General information

NPI: 1720110943
Provider Name (Legal Business Name): JANET CHERYL GRINIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 13TH AVE
MADAWASKA ME
04756-1289
US

IV. Provider business mailing address

165 13TH AVE
MADAWASKA ME
04756-1289
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-4470
  • Fax: 207-834-4473
Mailing address:
  • Phone: 207-834-4470
  • Fax: 207-834-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC5677
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: