Provider Demographics
NPI:1679626121
Name:GRILL, RHODA (LICSW)
Entity type:Individual
Prefix:
First Name:RHODA
Middle Name:
Last Name:GRILL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GREENLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1714
Mailing Address - Country:US
Mailing Address - Phone:617-244-1454
Mailing Address - Fax:
Practice Address - Street 1:8 ALTON PL STE 5
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6448
Practice Address - Country:US
Practice Address - Phone:617-738-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02340OtherBLUE CROSSBLUE SHIELD
MA257579OtherMAGELLAN HEALTH
MA257579OtherMAGELLAN HEALTH