Provider Demographics
NPI:1598870305
Name:GRIGGS, LEIGH J (LICSW)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:J
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2213
Mailing Address - Country:US
Mailing Address - Phone:774-275-0999
Mailing Address - Fax:
Practice Address - Street 1:1900 W PARK DR
Practice Address - Street 2:SUITE 280
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3942
Practice Address - Country:US
Practice Address - Phone:774-275-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23333Medicare ID - Type Unspecified