Provider Demographics
NPI:1053026120
Name:GRIGOLI, JENNIFER L (PMHNP, DNS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:GRIGOLI
Suffix:
Gender:F
Credentials:PMHNP, DNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1019
Mailing Address - Country:US
Mailing Address - Phone:607-832-5888
Mailing Address - Fax:
Practice Address - Street 1:243 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1019
Practice Address - Country:US
Practice Address - Phone:604-832-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404681363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY404681OtherPMHNP