Provider Demographics
NPI:1528001971
Name:GRIFFIN, LAWRENCE ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 JFK BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7421
Mailing Address - Country:US
Mailing Address - Phone:215-640-0600
Mailing Address - Fax:215-640-0914
Practice Address - Street 1:1800 JFK BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19103-7421
Practice Address - Country:US
Practice Address - Phone:215-640-0600
Practice Address - Fax:215-640-0914
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002036L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR081169Medicare ID - Type Unspecified