Provider Demographics
NPI:1902018419
Name:GRIMALDI, JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:GRIMALDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 W LINEBAUGH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5815
Mailing Address - Country:US
Mailing Address - Phone:813-269-2920
Mailing Address - Fax:813-269-2021
Practice Address - Street 1:6916 W LINEBAUGH AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5815
Practice Address - Country:US
Practice Address - Phone:813-269-2920
Practice Address - Fax:813-269-2021
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3551.Medicare ID - Type UnspecifiedMEDICARE PART B PROV NUM