Provider Demographics
NPI:1740332311
Name:GRIMM, CARL T (LCSW)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:T
Last Name:GRIMM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2011
Mailing Address - Country:US
Mailing Address - Phone:201-965-7628
Mailing Address - Fax:201-461-2430
Practice Address - Street 1:20 WILSEY SQ
Practice Address - Street 2:SUITE C
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3793
Practice Address - Country:US
Practice Address - Phone:201-445-1068
Practice Address - Fax:201-445-7995
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055502104100000X
NJ44SC051566001041C0700X
FLSW69631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical