Provider Demographics
NPI:1558480962
Name:GRIFFITH, CAROL E (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:E
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 BRIDGE PLZ
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-2201
Mailing Address - Country:US
Mailing Address - Phone:315-210-6475
Mailing Address - Fax:315-210-6475
Practice Address - Street 1:1 BRIDGE PLZ
Practice Address - Street 2:SUITE 205
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2201
Practice Address - Country:US
Practice Address - Phone:315-210-6475
Practice Address - Fax:315-210-6475
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY9705103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD0958Medicare PIN