Healthcare Provider Details

I. General information

NPI: 1154299550
Provider Name (Legal Business Name): RACHEL GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 27TH ST W
BRADENTON FL
34207-1768
US

IV. Provider business mailing address

9318 GRAND HARVEST CT
RIVERVIEW FL
33578-4118
US

V. Phone/Fax

Practice location:
  • Phone: 941-753-0064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: