Healthcare Provider Details

I. General information

NPI: 1144374000
Provider Name (Legal Business Name): STEFANIE GRIFFIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST STE 4144
DOVER NH
03820-2236
US

IV. Provider business mailing address

16 PINECREST LN
DURHAM NH
03824-3112
US

V. Phone/Fax

Practice location:
  • Phone: 603-740-6371
  • Fax:
Mailing address:
  • Phone: 603-496-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1026
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: