Healthcare Provider Details

I. General information

NPI: 1295854859
Provider Name (Legal Business Name): DONNA DOUGLASS GRIFFITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 SACRAMENTO ST
SAN FRANCISCO CA
94118-1709
US

IV. Provider business mailing address

3663 SACRAMENTO ST
SAN FRANCISCO CA
94118-1709
US

V. Phone/Fax

Practice location:
  • Phone: 415-929-8086
  • Fax:
Mailing address:
  • Phone: 415-929-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12332
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY12332
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: