Provider Demographics
NPI:1245273887
Name:GRIFFIN, KERRI L (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-0564
Mailing Address - Country:US
Mailing Address - Phone:860-336-8575
Mailing Address - Fax:860-779-1128
Practice Address - Street 1:553 HARTFORD PIKE
Practice Address - Street 2:SUITE 4 BELL PARK PROFESSIONAL SUITES
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-2150
Practice Address - Country:US
Practice Address - Phone:860-336-8575
Practice Address - Fax:860-779-1128
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0049491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002647Medicare PIN