Provider Demographics
NPI:1790153740
Name:GRIM, BARBARA JEAN
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:GRIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HOLBROOK ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056
Mailing Address - Country:US
Mailing Address - Phone:781-742-4581
Mailing Address - Fax:508-377-3752
Practice Address - Street 1:65 HOLBROOK ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:781-742-4581
Practice Address - Fax:508-377-3752
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALMHC10002572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000023532OtherBMC
MA1303287OtherMBHP
MAM18633OtherBCBS
MA042611055OtherTAX ID
MA1303287Medicaid
MA1004745OtherNHP
MA99618201OtherNETWORKHEALTH