Healthcare Provider Details

I. General information

NPI: 1982285136
Provider Name (Legal Business Name): GRIDANIA CHRISTY JEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NEWBURY ST
DANVERS MA
01923-1087
US

IV. Provider business mailing address

100 NEWBURY ST
DANVERS MA
01923-1087
US

V. Phone/Fax

Practice location:
  • Phone: 800-778-5560
  • Fax:
Mailing address:
  • Phone: 800-778-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10001143
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: