MEDICARE: EMILY RAYMOND GRIFFIN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW02221	RI

General Provider Information

NPI Number	:	1467871426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY RAYMOND GRIFFIN LICSW

Provider Business Mailing Address
First Line	:	59 ERIE ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-1219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MAIN ST
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-4131
Country	:	US
Telephone Number	:	401-728-1800
Fax Number	:	401-728-0182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	04/07/2014

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