Healthcare Provider Details

I. General information

NPI: 1063185346
Provider Name (Legal Business Name): MELISSA CLAIRE GRIFFIN RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2021
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 SWORDFISH LN
SPRING HILL FL
34609-3649
US

IV. Provider business mailing address

412 MARY ELLEN CT
WINTER GARDEN FL
34787-2694
US

V. Phone/Fax

Practice location:
  • Phone: 601-938-2941
  • Fax:
Mailing address:
  • Phone: 601-938-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW15804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: