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General NPI Number Information
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NPI Number | 1023645850
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Entity Type | Individual
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Provider Name | KATHRYN GRIMES
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 166 MAIN ST
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City | MATAWAN
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State | NJ
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Zip | 07747-3104
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Country | US
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Telephone | 732-690-1356
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Fax |
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Provider Business Mailing Address
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Address Line | 1933 STATE ROUTE 35
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City | WALL TOWNSHIP
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State | NJ
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Zip | 07719-3502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06557000
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License Number State | NJ
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