Provider Demographics
NPI:1649245994
Name:GRIMM, HOLLY ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ANNE
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:ANNE
Other - Last Name:GLATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:999 W CHESTER PIKE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4877
Mailing Address - Country:US
Mailing Address - Phone:610-429-4100
Mailing Address - Fax:610-429-1570
Practice Address - Street 1:999 W CHESTER PIKE
Practice Address - Street 2:SUITE B-1
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4877
Practice Address - Country:US
Practice Address - Phone:610-429-4100
Practice Address - Fax:610-429-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0147431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA082419Medicare ID - Type Unspecified