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General NPI Number Information
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NPI Number | 1184184806
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Entity Type | Individual
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Provider Name | JESSICA FLORA GRILL LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 36 MIDDLESEX TPKE
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City | BEDFORD
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State | MA
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Zip | 01730-1404
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Country | US
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Telephone | 617-738-5600
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Fax | 781-290-4923
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Provider Business Mailing Address
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Address Line | 181 FOREST ST
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City | ARLINGTON
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State | MA
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Zip | 02474-8903
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Country | US
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Telephone | 781-641-3706
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 1023013
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 1023013
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License Number State | MA
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