Provider Demographics
NPI:1235556812
Name:GRIMM, RAYMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:GRIMM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40425 CARMELITA CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3602
Mailing Address - Country:US
Mailing Address - Phone:510-366-0975
Mailing Address - Fax:
Practice Address - Street 1:3100 MOWRY AVE STE 402
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1509
Practice Address - Country:US
Practice Address - Phone:510-366-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist