Healthcare Provider Details

I. General information

NPI: 1063280220
Provider Name (Legal Business Name): CARMONA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W MARKET ST
AKRON OH
44303-1411
US

IV. Provider business mailing address

3584 HARRIS AVE NW
CANTON OH
44708-1021
US

V. Phone/Fax

Practice location:
  • Phone: 330-815-7240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: