Healthcare Provider Details

I. General information

NPI: 1659063006
Provider Name (Legal Business Name): ELM PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BLOOMFIELD AVE STE 201-3
CALDWELL NJ
07006
US

IV. Provider business mailing address

5 WATERBURY RD
MONTCLAIR NJ
07043-1713
US

V. Phone/Fax

Practice location:
  • Phone: 347-806-1348
  • Fax:
Mailing address:
  • Phone: 347-806-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MOLLY L GRIMES
Title or Position: OWNER
Credential: PSYD
Phone: 347-806-1348