Provider Demographics
NPI:1275812836
Name:GRIFFIN, KHALILAH
Entity Type:Individual
Prefix:MS
First Name:KHALILAH
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W 148TH ST
Mailing Address - Street 2:APT. 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3127
Mailing Address - Country:US
Mailing Address - Phone:850-321-7695
Mailing Address - Fax:
Practice Address - Street 1:206 W 148TH ST
Practice Address - Street 2:APT. 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3127
Practice Address - Country:US
Practice Address - Phone:850-321-7695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst