Provider Demographics
NPI:1326281254
Name:GRISWOLD, PATRICIA E (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4064
Mailing Address - Country:US
Mailing Address - Phone:937-885-5105
Mailing Address - Fax:937-528-6896
Practice Address - Street 1:2132 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-1991
Practice Address - Country:US
Practice Address - Phone:937-528-6850
Practice Address - Fax:937-528-6896
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00045621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical