Healthcare Provider Details

I. General information

NPI: 1255313557
Provider Name (Legal Business Name): BERNADETTE HAYES GRIFFIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E CENTRAL AVE
PEARL RIVER NY
10965-2537
US

IV. Provider business mailing address

180 E CENTRAL AVE
PEARL RIVER NY
10965-2537
US

V. Phone/Fax

Practice location:
  • Phone: 845-735-3881
  • Fax:
Mailing address:
  • Phone: 845-735-3881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR0153391
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number445C01290300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11434CASAC
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: