Healthcare Provider Details

I. General information

NPI: 1962399535
Provider Name (Legal Business Name): MRS. REBECCA LYNNMARIE GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WEAVER DAM RD
PETERSBURG NY
12138-5220
US

IV. Provider business mailing address

111 WEAVER DAM RD
PETERSBURG NY
12138-5220
US

V. Phone/Fax

Practice location:
  • Phone: 518-330-9383
  • Fax:
Mailing address:
  • Phone: 518-330-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: