Provider Demographics
NPI:1093880940
Name:GRIFFITH, GEORGE J JR (MED CASAC LMHC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:J
Last Name:GRIFFITH
Suffix:JR
Gender:M
Credentials:MED CASAC LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 LITTLE YORK CROSSING
Mailing Address - Street 2:PO BOX 151
Mailing Address - City:LITTLE YORK
Mailing Address - State:NY
Mailing Address - Zip Code:13087
Mailing Address - Country:US
Mailing Address - Phone:607-749-7575
Mailing Address - Fax:607-753-0768
Practice Address - Street 1:7 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:LORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-758-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0026461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health