Provider Demographics
NPI:1629829692
Name:GRILLOT, CHARLOTTE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:L
Last Name:GRILLOT
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 1:870 RIVERSIDE DR APT 7D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-5473
Mailing Address - Country:US
Mailing Address - Phone:347-612-1399
Mailing Address - Fax:
Practice Address - Street 1:870 RIVERSIDE DR APT 7D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5473
Practice Address - Country:US
Practice Address - Phone:347-612-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-P127632-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical