Healthcare Provider Details

I. General information

NPI: 1760127146
Provider Name (Legal Business Name): ALESSANDRA R GRILLO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2022
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 BELLE VIEW BLVD STE 5441
ALEXANDRIA VA
22307-6530
US

IV. Provider business mailing address

1520 BELLE VIEW BLVD STE 5441
ALEXANDRIA VA
22307-6530
US

V. Phone/Fax

Practice location:
  • Phone: 315-345-0857
  • Fax:
Mailing address:
  • Phone: 315-345-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009204
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: