Provider Demographics
NPI:1700189024
Name:GRIMM, ANDREW JAMES (LSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JAMES
Last Name:GRIMM
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SCOTLAND LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-1368
Mailing Address - Country:US
Mailing Address - Phone:724-652-2211
Mailing Address - Fax:
Practice Address - Street 1:700 SCOTLAND LN
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-1368
Practice Address - Country:US
Practice Address - Phone:724-652-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health