Provider Demographics
NPI:1558879338
Name:LOTUS PSYCHOTHERAPY OF FAIRFIELD COUNTY, PLLC
Entity Type:Organization
Organization Name:LOTUS PSYCHOTHERAPY OF FAIRFIELD COUNTY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMALDI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-536-7005
Mailing Address - Street 1:6 THORNDAL CIR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5415
Mailing Address - Country:US
Mailing Address - Phone:203-536-7005
Mailing Address - Fax:
Practice Address - Street 1:6 THORNDAL CIR
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5415
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:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008763251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health