Provider Demographics
NPI:1609971035
Name:GRIMALDI, LAWRENCE STEPHEN (MA LMAC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:STEPHEN
Last Name:GRIMALDI
Suffix:
Gender:M
Credentials:MA LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BRIERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930
Mailing Address - Country:US
Mailing Address - Phone:978-281-0020
Mailing Address - Fax:
Practice Address - Street 1:81 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-354-4550
Practice Address - Fax:978-745-9021
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3040101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor