Provider Demographics
NPI:1104083732
Name:GRILLO, MARY B (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:B
Last Name:GRILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 E HARGETT ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1517
Mailing Address - Country:US
Mailing Address - Phone:919-856-5282
Mailing Address - Fax:919-664-7721
Practice Address - Street 1:567 E HARGETT ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1517
Practice Address - Country:US
Practice Address - Phone:919-856-5282
Practice Address - Fax:919-664-7721
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0058521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical