Provider Demographics
NPI:1518333913
Name:GRIFFIN, LEIF (PSYD)
Entity type:Individual
Prefix:
First Name:LEIF
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E PROSPECT AVE STE 1002
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3709
Mailing Address - Country:US
Mailing Address - Phone:510-898-8806
Mailing Address - Fax:
Practice Address - Street 1:180 E PROSPECT AVE STE 1002
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3709
Practice Address - Country:US
Practice Address - Phone:510-898-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31909103TC0700X
NY025233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical