Provider Demographics
NPI:1730679861
Name:MARYANN Y GRIMALDI LMFT, LLC
Entity Type:Organization
Organization Name:MARYANN Y GRIMALDI LMFT, LLC
Other - Org Name:MARYANN Y GRIMALDI LMFT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GRIMALDI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-214-6194
Mailing Address - Street 1:3000 WHITNEY AVE STE 288
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2353
Mailing Address - Country:US
Mailing Address - Phone:203-214-6194
Mailing Address - Fax:
Practice Address - Street 1:147 DURHAM RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2675
Practice Address - Country:US
Practice Address - Phone:203-214-6194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty