Provider Demographics
NPI:1457452799
Name:GRINNELL, BARBARA LYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LYN
Last Name:GRINNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 REMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2325
Mailing Address - Country:US
Mailing Address - Phone:610-642-8142
Mailing Address - Fax:
Practice Address - Street 1:1009 REMINGTON RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2325
Practice Address - Country:US
Practice Address - Phone:610-642-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003723L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000196872Medicare ID - Type UnspecifiedPSYCHOLOGIST