1366453631 NPI number — MS. JENNIFER ELLEN GRIFFIN LICSW

Table of content: MS. JENNIFER ELLEN GRIFFIN LICSW (NPI 1366453631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366453631 NPI number — MS. JENNIFER ELLEN GRIFFIN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
JENNIFER
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366453631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LAHEY HEALTH PRIMARY CARE, IPSWICH
Provider Second Line Business Mailing Address:
36 ESSEX ROAD
Provider Business Mailing Address City Name:
IPSWICH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01938-2599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-356-5522
Provider Business Mailing Address Fax Number:
978-356-0218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CUMMINGS CTR
Provider Second Line Business Practice Location Address:
SUITE 266T
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915-6175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-921-1190
Provider Business Practice Location Address Fax Number:
978-927-3724
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  108015 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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