Provider Demographics
NPI:1679617070
Name:GRIFFITH, JENNIFER L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:REGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 JAQUES AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2476
Mailing Address - Country:US
Mailing Address - Phone:978-365-2803
Mailing Address - Fax:978-365-1960
Practice Address - Street 1:72 JAQUES AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2476
Practice Address - Country:US
Practice Address - Phone:978-365-2803
Practice Address - Fax:978-365-1960
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10272591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical