Provider Demographics
NPI:1881302958
Name:GRIMALDI, KRISTEN (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 GEORGE URBAN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-2022
Mailing Address - Country:US
Mailing Address - Phone:716-364-7212
Mailing Address - Fax:
Practice Address - Street 1:2475 GEORGE URBAN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-2022
Practice Address - Country:US
Practice Address - Phone:716-364-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088168-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker