Healthcare Provider Details

I. General information

NPI: 1720076599
Provider Name (Legal Business Name): FRANCES M GRIFFIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 PIKE ST
PORT JERVIS NY
12771-1808
US

IV. Provider business mailing address

146 PIKE ST
PORT JERVIS NY
12771-1808
US

V. Phone/Fax

Practice location:
  • Phone: 845-858-1456
  • Fax: 845-858-1459
Mailing address:
  • Phone: 845-858-1456
  • Fax: 845-858-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number051608-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: