Healthcare Provider Details

I. General information

NPI: 1366453631
Provider Name (Legal Business Name): JENNIFER ELLEN GRIFFIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CUMMINGS CTR SUITE 266T
BEVERLY MA
01915-6175
US

IV. Provider business mailing address

LAHEY HEALTH PRIMARY CARE, IPSWICH 36 ESSEX ROAD
IPSWICH MA
01938-2599
US

V. Phone/Fax

Practice location:
  • Phone: 978-921-1190
  • Fax: 978-927-3724
Mailing address:
  • Phone: 978-356-5522
  • Fax: 978-356-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108015
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: