Provider Demographics
NPI:1609138148
Name:GRIFFIN, RONALD ANTHONY (LMSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ANTHONY
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 1ST AVE NE
Mailing Address - Street 2:SUITE 111F
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4170
Mailing Address - Country:US
Mailing Address - Phone:507-513-0239
Mailing Address - Fax:
Practice Address - Street 1:1500 1ST AVE NE
Practice Address - Street 2:SUITE 111F
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4170
Practice Address - Country:US
Practice Address - Phone:507-513-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker