Healthcare Provider Details

I. General information

NPI: 1598765992
Provider Name (Legal Business Name): LISA J. GRIFFIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA GOODMAN MSW

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 EAST PARIS AVE SE SUITE 220
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

61 COMMERCE AVE SW
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-0238
  • Fax: 616-285-7211
Mailing address:
  • Phone: 616-940-0660
  • Fax: 616-940-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801057233
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: