Provider Demographics
NPI:1649528597
Name:GRILLO, KIMBERLY (MSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GRILLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 WARBOYS RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:NY
Mailing Address - Zip Code:14422-9553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5130 E MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3444
Practice Address - Country:US
Practice Address - Phone:585-344-1421
Practice Address - Fax:585-344-8030
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor