Provider Demographics
NPI:1659432540
Name:GRISWOLD, GERMAINE ANITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERMAINE
Middle Name:ANITA
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1034
Mailing Address - Country:US
Mailing Address - Phone:973-715-4691
Mailing Address - Fax:
Practice Address - Street 1:115 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1034
Practice Address - Country:US
Practice Address - Phone:973-715-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4470OtherNJ STATE LICENSE