Healthcare Provider Details

I. General information

NPI: 1265650626
Provider Name (Legal Business Name): MICHAEL GRIFFIN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE DEPARTMENT OF PSYCHIATRY
SALEM MA
01970-2714
US

IV. Provider business mailing address

81 HIGHLAND AVE A8
SALEM MA
01970-2714
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-4010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113424
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: