Provider Demographics
NPI:1083202311
Name:GRIMALDI, CAITLIN (MAO)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:MAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 CAMBRIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2830
Mailing Address - Country:US
Mailing Address - Phone:860-303-6358
Mailing Address - Fax:
Practice Address - Street 1:91 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2509
Practice Address - Country:US
Practice Address - Phone:860-303-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT786171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist