Provider Demographics
NPI:1528614054
Name:GRIMALDI, STEPHANIE (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FURNACE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-2103
Mailing Address - Country:US
Mailing Address - Phone:860-543-1652
Mailing Address - Fax:
Practice Address - Street 1:21 HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076-1507
Practice Address - Country:US
Practice Address - Phone:860-684-4239
Practice Address - Fax:860-684-0511
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist