Healthcare Provider Details

I. General information

NPI: 1710033998
Provider Name (Legal Business Name): SUSAN S. GRIFFIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JERMAIN AVE
SAG HARBOR NY
11963-3412
US

IV. Provider business mailing address

110 JERMAIN AVE PO BOX 1551
SAG HARBOR NY
11963-3412
US

V. Phone/Fax

Practice location:
  • Phone: 631-725-2978
  • Fax:
Mailing address:
  • Phone: 631-725-2978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR030088
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR030088
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: