Provider Demographics
NPI:1548281199
Name:GRILLO, STEPHEN JOSEPH (EDM, LPC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:GRILLO
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Gender:M
Credentials:EDM, LPC
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Mailing Address - Street 1:1204 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2922
Mailing Address - Country:US
Mailing Address - Phone:215-334-1684
Mailing Address - Fax:610-497-7711
Practice Address - Street 1:2600 W 9TH ST
Practice Address - Street 2:ADULT MENTAL HEALTH, SUITE 360 (3RD FLOOR)
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2040
Practice Address - Country:US
Practice Address - Phone:610-497-7639
Practice Address - Fax:610-497-7711
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPC002981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional