Provider Demographics
NPI:1184184806
Name:GRILL, JESSICA FLORA (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FLORA
Last Name:GRILL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:FLORA
Other - Last Name:SCHLESINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:181 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8903
Mailing Address - Country:US
Mailing Address - Phone:781-641-3706
Mailing Address - Fax:
Practice Address - Street 1:36 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1404
Practice Address - Country:US
Practice Address - Phone:617-738-5600
Practice Address - Fax:781-290-4923
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023013101YS0200X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool