Provider Demographics
NPI:1629421888
Name:GRIFFIN, CHERYL (MA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CINDY LN UNIT E
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7249
Mailing Address - Country:US
Mailing Address - Phone:732-578-8621
Mailing Address - Fax:732-578-8622
Practice Address - Street 1:43 CINDY LN UNIT E
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7249
Practice Address - Country:US
Practice Address - Phone:732-578-8621
Practice Address - Fax:732-578-8622
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ81-3309976Medicaid