Provider Demographics
NPI:1578711685
Name:GRINNELL, THOMAS DONALD JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DONALD
Last Name:GRINNELL
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:255 DELAWARE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2016
Mailing Address - Country:US
Mailing Address - Phone:716-842-0440
Mailing Address - Fax:716-842-4069
Practice Address - Street 1:625 DELAWARE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1009
Practice Address - Country:US
Practice Address - Phone:716-882-3151
Practice Address - Fax:716-886-4002
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2012-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY079421-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical