Provider Demographics
NPI:1083793152
Name:GRIFFIN, COREY ALBERT (PHD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ALBERT
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:JEANNE
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 60044
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-0044
Mailing Address - Country:US
Mailing Address - Phone:413-219-2543
Mailing Address - Fax:413-268-0034
Practice Address - Street 1:26 S PROSPECT ST STE 17
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2274
Practice Address - Country:US
Practice Address - Phone:413-219-2543
Practice Address - Fax:413-268-0034
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8475103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist