Provider Demographics
NPI:1730232547
Name:GRISCO, TINA LOUISE (LCSW, LADC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:LOUISE
Last Name:GRISCO
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:MULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANDISFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01255
Mailing Address - Country:US
Mailing Address - Phone:860-793-4421
Mailing Address - Fax:860-793-4440
Practice Address - Street 1:80 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-4013
Practice Address - Country:US
Practice Address - Phone:860-738-5940
Practice Address - Fax:860-379-1013
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065951041C0700X
CT00065951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical