Provider Demographics
NPI:1528500097
Name:GRIMALDO, VICTORIA (CDCA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GRIMALDO
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 PENLAWN CT
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-9536
Mailing Address - Country:US
Mailing Address - Phone:740-326-1809
Mailing Address - Fax:
Practice Address - Street 1:59 PENLAWN CT
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:OH
Practice Address - Zip Code:43028-9536
Practice Address - Country:US
Practice Address - Phone:740-326-1809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.161935101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)