Provider Demographics
NPI:1558920231
Name:GRIMA, JUDY ANN (CASAC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:GRIMA
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4905
Mailing Address - Country:US
Mailing Address - Phone:516-799-3203
Mailing Address - Fax:
Practice Address - Street 1:75 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4905
Practice Address - Country:US
Practice Address - Phone:516-799-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)