Provider Demographics
NPI:1689021016
Name:GRISDALE, MARIAN ELIZABETH (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:ELIZABETH
Last Name:GRISDALE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 PEARL RD
Mailing Address - Street 2:SUITE 299
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3813
Mailing Address - Country:US
Mailing Address - Phone:440-345-5300
Mailing Address - Fax:440-882-3048
Practice Address - Street 1:6500 PEARL RD
Practice Address - Street 2:SUITE 299
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3813
Practice Address - Country:US
Practice Address - Phone:440-345-5300
Practice Address - Fax:440-882-3048
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007963-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical