MEDICARE: JUDITH ELAINE GRIFFIN LCSW

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	LCS18395	CA

General Provider Information

NPI Number	:	1912039199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ELAINE GRIFFIN LCSW

Provider Business Mailing Address
First Line	:	446 LINDEN AVE
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-5227
Country	:	US
Telephone Number	:	530-823-2619
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CIRBY HILLS DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-4360
Country	:	US
Telephone Number	:	916-787-8884
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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