Healthcare Provider Details

I. General information

NPI: 1366304156
Provider Name (Legal Business Name): JUSTINE GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 CHESTNUT ST
NEEDHAM MA
02492-2505
US

IV. Provider business mailing address

399 PUTNAM AVE APT 1
CAMBRIDGE MA
02139-4607
US

V. Phone/Fax

Practice location:
  • Phone: 781-453-3000
  • Fax:
Mailing address:
  • Phone: 203-214-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2339941
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: