Provider Demographics
NPI:1396018669
Name:GRIFFIN, MARY ELIZABETH (MS-SPEECH PATHOLOGY)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS-SPEECH PATHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 DEERK PARK AVENUE
Mailing Address - Street 2:DEER PARK UNION FREE SCHOOL DISTRICT
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729
Mailing Address - Country:US
Mailing Address - Phone:631-274-4001
Mailing Address - Fax:631-242-6762
Practice Address - Street 1:1881 DEER PARK AVE
Practice Address - Street 2:DEER PARK UNION FREE SCHOOL DISTRICT
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729
Practice Address - Country:US
Practice Address - Phone:631-274-4001
Practice Address - Fax:631-242-6762
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004357-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist