Provider Demographics
NPI:1881886794
Name:GRIMALDI, BRIANA LIAN SCHAEFER (PSYD)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:LIAN SCHAEFER
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BAYOU ST
Mailing Address - Street 2:SAMARITAN CENTER
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1034
Mailing Address - Country:US
Mailing Address - Phone:812-886-6800
Mailing Address - Fax:812-886-6809
Practice Address - Street 1:515 BAYOU ST
Practice Address - Street 2:SAMARITAN CENTER
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1034
Practice Address - Country:US
Practice Address - Phone:812-886-6800
Practice Address - Fax:812-886-6809
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042268A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN444530QMedicare PIN