Provider Demographics
NPI:1891166252
Name:GRILLO, YOHANDRA C
Entity Type:Individual
Prefix:
First Name:YOHANDRA
Middle Name:C
Last Name:GRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CARNEGIE AVENUE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-8021
Mailing Address - Country:US
Mailing Address - Phone:973-388-4751
Mailing Address - Fax:877-744-8986
Practice Address - Street 1:108 CARNEGIE AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-0701
Practice Address - Country:US
Practice Address - Phone:973-388-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X, 172V00000X
NJ37FA00004200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty