Healthcare Provider Details

I. General information

NPI: 1215853619
Provider Name (Legal Business Name): JESSICA MAHLA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 DREW CT
JOPPA MD
21085-4416
US

IV. Provider business mailing address

104 DREW CT
JOPPA MD
21085-4416
US

V. Phone/Fax

Practice location:
  • Phone: 443-827-6705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25196
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: