Active NPI
Robin Jane Grimm, CAS
- Addiction (Substance Use Disorder) Counselor
- San Rafael, CA
National Provider Identifier
1861773723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 03-099467
- Practice address
- 1601 2ND St
Suite 104
San Rafael, CA 94901-2712 - Phone
- (415) 459-2395
- NPI assigned
- Sep 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 03-099467 | CA | Primary |
Addresses
Primary practice location
1601 2ND St
Suite 104
San Rafael, CA 94901-2712
Mailing address
622 Palm Ave
Penngrove, CA 94951-9679
Phone (415) 637-7179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03-099467 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315267200000",
"number": "1861773723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 PALM AVE",
"city": "PENNGROVE",
"state": "CA",
"postal_code": "949519679",
"telephone_number": "415-637-7179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 2ND ST",
"address_2": "SUITE 104",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949012712",
"telephone_number": "415-459-2395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMM",
"first_name": "ROBIN",
"middle_name": "JANE",
"name_prefix": "Ms.",
"credential": "CAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-06",
"last_updated": "2011-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "03-099467",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.