Provider Demographics
NPI:1528618212
Name:GRILLI-CLARK, CASSANDRA (MA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:GRILLI-CLARK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-0597
Mailing Address - Country:US
Mailing Address - Phone:717-285-7121
Mailing Address - Fax:
Practice Address - Street 1:2330 VARTAN WAY STE 204
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9763
Practice Address - Country:US
Practice Address - Phone:717-920-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health