Provider Demographics
NPI:1790993566
Name:GRIMES, KARIN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KARIN
Middle Name:M
Last Name:GRIMES
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 1:154 N HUMPHREY AVE APT J1
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2557
Mailing Address - Country:US
Mailing Address - Phone:708-299-2810
Mailing Address - Fax:708-383-1164
Practice Address - Street 1:1010 LAKE STREET
Practice Address - Street 2:SUITE 502A
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1135
Practice Address - Country:US
Practice Address - Phone:708-383-5354
Practice Address - Fax:708-383-1164
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0007431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01627825OtherBLUE CROSS BLUE SHIELD IL