Healthcare Provider Details

I. General information

NPI: 1821322157
Provider Name (Legal Business Name): DONNA DIPETRA GRIFFITHS BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 SHOEMAKER RD STE 230
KING OF PRUSSIA PA
19406-4238
US

IV. Provider business mailing address

583 SHOEMAKER RD STE 230
KING OF PRUSSIA PA
19406-4238
US

V. Phone/Fax

Practice location:
  • Phone: 484-681-2170
  • Fax:
Mailing address:
  • Phone: 484-681-2170
  • Fax: 866-309-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0-03-0986
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-03-0986
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: