Provider Demographics
NPI:1093042277
Name:LEE ANN GRISOLANO PHD PC
Entity Type:Organization
Organization Name:LEE ANN GRISOLANO PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-387-2455
Mailing Address - Street 1:405 E CHOCOLATE AVE
Mailing Address - Street 2:2ND FLOORE
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1331
Mailing Address - Country:US
Mailing Address - Phone:717-533-2601
Mailing Address - Fax:
Practice Address - Street 1:405 E CHOCOLATE AVE
Practice Address - Street 2:2ND FLOORE
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1331
Practice Address - Country:US
Practice Address - Phone:717-533-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009033L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty