Provider Demographics
NPI:1457631194
Name:GRIFFITH, PENELOPE LISA (MSW, LICSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:LISA
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 ANN ARBOR LANE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716
Mailing Address - Country:US
Mailing Address - Phone:301-928-8707
Mailing Address - Fax:301-249-4890
Practice Address - Street 1:2512 ANN ARBOR LANE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-928-8707
Practice Address - Fax:301-249-4890
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3029871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD365116900Medicaid