Provider Demographics
NPI:1376673640
Name:GRIMALDO, MARINA ANN (MFTI)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:ANN
Last Name:GRIMALDO
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4984 E IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3029
Mailing Address - Country:US
Mailing Address - Phone:559-456-2664
Mailing Address - Fax:
Practice Address - Street 1:4984 E IOWA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3029
Practice Address - Country:US
Practice Address - Phone:559-456-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health