Provider Demographics
NPI:1619085107
Name:GRIMM, CYNTHIA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:S
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1740
Mailing Address - Country:US
Mailing Address - Phone:908-221-0531
Mailing Address - Fax:
Practice Address - Street 1:239 NEW RD
Practice Address - Street 2:BUILDING C
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4274
Practice Address - Country:US
Practice Address - Phone:973-227-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046317001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001727Medicare ID - Type UnspecifiedLCSW