Provider Demographics
NPI:1629628789
Name:GRIMME, AMBER MAE (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MAE
Last Name:GRIMME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAE
Other - Middle Name:
Other - Last Name:GRIMME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1904 RICHLAND AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-4562
Mailing Address - Country:US
Mailing Address - Phone:209-300-8800
Mailing Address - Fax:
Practice Address - Street 1:1904 RICHLAND AVE BLDG A
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-300-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1139001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical