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General NPI Number Information
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NPI Number | 1255143970
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Entity Type | Individual
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Provider Name | SAMANTHA GRIMM
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Gender | Female
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 31 WALTER ST
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City | ALBANY
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State | NY
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Zip | 12204-1604
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Country | US
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Telephone | 518-646-2703
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Fax |
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Provider Business Mailing Address
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Address Line | ACP 3661 PO BOX 1110
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City | ALBANY
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State | NY
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Zip | 12201
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Country | US
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Telephone | 518-301-3773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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