Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003240060 |
---|---|
Provider Name | Grimaldi Martinez |
First Address | Middle Village, NY 11379-2949 |
Second Address | Brooklyn, NY 11223-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2013 |
Last Update Date | 27/08/2013 |