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NPI Code Detail

MEDICARE: MARISA SIERRA GRIM

MEDICARE: MARISA SIERRA GRIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6851118306MI
2175T00000XPeer Specialist

General Provider Information

NPI Number : 1780312660
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISA SIERRA GRIM
Provider Business Mailing Address
First Line : 35280 FLORENCE ST
Second Line :
City : WESTLAND
State : MI
Zip : 48185-3609
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 30000 HIVELEY ST
Second Line :
City : INKSTER
State : MI
Zip : 48141-1089
Country : US
Telephone Number : 734-261-1842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2022
Last Update Date : 03/27/2026

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Directions to “ MARISA SIERRA GRIM ” Practice Location

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