Provider Demographics
NPI:1578654554
Name:GRIMES, KRISTINE J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:J
Last Name:GRIMES
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 1:384 INGALLS RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:MA
Mailing Address - Zip Code:01225-9733
Mailing Address - Country:US
Mailing Address - Phone:413-664-4541
Mailing Address - Fax:
Practice Address - Street 1:25 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2451
Practice Address - Country:US
Practice Address - Phone:413-664-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical