Provider Demographics
NPI:1073672549
Name:GRIGNETTI, JANE BARNETT (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:BARNETT
Last Name:GRIGNETTI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6807
Mailing Address - Country:US
Mailing Address - Phone:781-862-5674
Mailing Address - Fax:781-862-5674
Practice Address - Street 1:18 HASTINGS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6807
Practice Address - Country:US
Practice Address - Phone:781-862-5674
Practice Address - Fax:781-862-5674
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA.1000941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1990Medicare UPIN