Provider Demographics
NPI:1609300367
Name:GRIFFITHS, TREVOR (LMSW, CASAC2)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:
Last Name:GRIFFITHS
Suffix:
Gender:M
Credentials:LMSW, CASAC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 RIVERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-4059
Mailing Address - Country:US
Mailing Address - Phone:347-961-6124
Mailing Address - Fax:
Practice Address - Street 1:1444 SHAKESPEARE AVE APT 24
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1843
Practice Address - Country:US
Practice Address - Phone:347-989-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1144511041C0700X
NY30648101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY114451Medicaid