Provider Demographics
NPI:1023327327
Name:GRIFFIN, WILLARD HENRY JR (LMSW-CC)
Entity type:Individual
Prefix:MR
First Name:WILLARD
Middle Name:HENRY
Last Name:GRIFFIN
Suffix:JR
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04002-6957
Mailing Address - Country:US
Mailing Address - Phone:207-251-0488
Mailing Address - Fax:
Practice Address - Street 1:470 FOREST AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2009
Practice Address - Country:US
Practice Address - Phone:207-774-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC12584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker