Provider Demographics
NPI:1174013718
Name:GRIFFITH, REBECCA R (LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:R
Other - Last Name:CONAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:527 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1227
Mailing Address - Country:US
Mailing Address - Phone:330-797-0070
Mailing Address - Fax:
Practice Address - Street 1:527 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1227
Practice Address - Country:US
Practice Address - Phone:330-797-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802935104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker