| Doctor Name: | MR. MICHAEL GRINNELL |
| NPI Number: | 1083082614 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | S40690186 |
| Business Practice Address: | 555 Amory St Jamaica Plain, MA - 021302652 |
| Business Phone Number: | 6175220901 |
| Business Fax Number: | |
| Mailing Address: | 29 Montcalm Ave, BRIGHTON |
| State: | MA |
| Postal Code: | 021352839 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2015 |
| NPI Last Update Date: | 09/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | S40690186 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |