Active NPI
Raymond Grimm, PH.D.
- Psychologist
- Fremont, CA
National Provider Identifier
1235556812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY30138
- Practice address
- 3100 Mowry Ave Ste 402
Fremont, CA 94538-1509 - Phone
- (510) 366-0975
- NPI assigned
- Mar 21, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY30138 | CA | Primary |
Addresses
Primary practice location
3100 Mowry Ave Ste 402
Fremont, CA 94538-1509
Mailing address
40425 Carmelita CT
Fremont, CA 94539-3602
Phone (510) 366-0975
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY30138 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549843200000",
"number": "1235556812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40425 CARMELITA CT",
"city": "FREMONT",
"state": "CA",
"postal_code": "945393602",
"telephone_number": "510-366-0975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 MOWRY AVE STE 402",
"city": "FREMONT",
"state": "CA",
"postal_code": "945381509",
"telephone_number": "510-366-0975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMM",
"first_name": "RAYMOND",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-03-21",
"last_updated": "2019-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY30138",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.