Provider Demographics
NPI:1013602127
Name:GRIMSLEY, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GRIMSLEY
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 1:200 BENEDICT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-2830
Mailing Address - Country:US
Mailing Address - Phone:413-441-9900
Mailing Address - Fax:
Practice Address - Street 1:333 EAST ST FL 3
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5369
Practice Address - Country:US
Practice Address - Phone:413-629-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
STUDENT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health