Provider Demographics
NPI:1982815429
Name:GRILLO, MAURA (LCSW)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:GRILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:90 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2507
Mailing Address - Country:US
Mailing Address - Phone:631-786-3182
Mailing Address - Fax:631-544-4578
Practice Address - Street 1:90 AVENUE K
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2507
Practice Address - Country:US
Practice Address - Phone:631-786-3182
Practice Address - Fax:631-544-4578
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075433-11041C0700X
NY0754331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical