Provider Demographics
NPI:1417300534
Name:GRIMES, PATRICIA (EDD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:GRIMES
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 GROVE ST
Mailing Address - Street 2:126
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5325
Mailing Address - Country:US
Mailing Address - Phone:203-966-5257
Mailing Address - Fax:
Practice Address - Street 1:69 GROVE ST
Practice Address - Street 2:126
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5325
Practice Address - Country:US
Practice Address - Phone:203-966-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT564103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist