Healthcare Provider Details

I. General information

NPI: 1669082962
Provider Name (Legal Business Name): LILLIANNA GRIGGS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HANCOCK ST
QUINCY MA
02169-4339
US

IV. Provider business mailing address

1250 HANCOCK ST
QUINCY MA
02169-4339
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-0920
  • Fax:
Mailing address:
  • Phone: 617-774-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2326872
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: