Provider Demographics
NPI:1346690229
Name:GRIFFIN, COLLEEN (MS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:GRIFFIN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:71 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2834
Mailing Address - Country:US
Mailing Address - Phone:914-963-3030
Mailing Address - Fax:914-674-8596
Practice Address - Street 1:71 BROADWAY
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2834
Practice Address - Country:US
Practice Address - Phone:914-963-3030
Practice Address - Fax:914-674-8596
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health