Provider Demographics
NPI:1801820717
Name:GRIFFIN, CAROLYN KEELAN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KEELAN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 BLUE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477
Mailing Address - Country:US
Mailing Address - Phone:845-246-9861
Mailing Address - Fax:
Practice Address - Street 1:292 BLUE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477
Practice Address - Country:US
Practice Address - Phone:845-246-9861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYSR05150511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1H093Medicare ID - Type Unspecified