MEDICARE: DR. LAWRENCE ROBERT GRIFFIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS002036L	PA

General Provider Information

NPI Number	:	1528001971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE ROBERT GRIFFIN PH.D.

Provider Business Mailing Address
First Line	:	1800 JFK BLVD
Second Line	:	SUITE 605
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7421
Country	:	US
Telephone Number	:	215-640-0600
Fax Number	:	215-640-0914

Provider Business Practice Location Address
First Line	:	1800 JFK BLVD
Second Line	:	SUITE 605
City	:	PHILA
State	:	PA
Zip	:	19103-7421
Country	:	US
Telephone Number	:	215-640-0600
Fax Number	:	215-640-0914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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