Provider Demographics
NPI:1417712787
Name:AMY GRIMALDI LCSW PA
Entity Type:Organization
Organization Name:AMY GRIMALDI LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMALDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-536-7005
Mailing Address - Street 1:110 E REYNOLDS ST STE 803
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3371
Mailing Address - Country:US
Mailing Address - Phone:203-536-7005
Mailing Address - Fax:
Practice Address - Street 1:110 E REYNOLDS ST STE 803
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3371
Practice Address - Country:US
Practice Address - Phone:203-536-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center