Provider Demographics
NPI:1437221926
Name:GRIMM DEFRANCO, MARGERY ALICE (MA LRC)
Entity Type:Individual
Prefix:MRS
First Name:MARGERY
Middle Name:ALICE
Last Name:GRIMM DEFRANCO
Suffix:
Gender:F
Credentials:MA LRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 WOODLAND RD
Mailing Address - Street 2:APT. 1
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2435
Mailing Address - Country:US
Mailing Address - Phone:973-218-0292
Mailing Address - Fax:
Practice Address - Street 1:1160 RAYMOND BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4168
Practice Address - Country:US
Practice Address - Phone:973-596-3971
Practice Address - Fax:973-596-3869
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37RC00155500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health