Provider Demographics
NPI:1235736265
Name:GRENOT, THERESA ANN (LSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:GRENOT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:A
Other - Last Name:GRENOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:236 BERKSHIRE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-1002
Mailing Address - Country:US
Mailing Address - Phone:973-713-7278
Mailing Address - Fax:
Practice Address - Street 1:217 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3602
Practice Address - Country:US
Practice Address - Phone:732-865-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059727001041C0700X
NJ44SL06393800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker