Provider Information for 1881285724
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SUSAN GRIMMO
Sex: Female
NPI: 1881285724
Last Updated: 2021-02-02
Certification Date: 2021-02-02
Certification Date: 2021-02-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1881285724 | ||||||||
| Enumeration Date | 2021-02-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9004 AVALON DR RANDOLPH, MA 02368-1571 United States Phone: 781-443-3997 | Fax: | ||||||||
| Primary Practice Address | 49 ROBINWOOD AVE JAMAICA PLAIN, MA 02130-2156 United States Phone: 617-390-1389 | Fax:617-390-1570 | ||||||||
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