Provider Demographics
NPI:1841362589
Name:GRIMALDI, DIANE LEE (RN, MS, CS)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LEE
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:RN, MS, CS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4 OCEAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4227
Mailing Address - Country:US
Mailing Address - Phone:978-283-3414
Mailing Address - Fax:978-231-2561
Practice Address - Street 1:90 CONCORD AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4046
Practice Address - Country:US
Practice Address - Phone:617-489-7354
Practice Address - Fax:617-489-8068
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA125374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional