Provider Demographics
NPI:1639551153
Name:JOHNSON GRIFFIN, JEROME
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:JOHNSON GRIFFIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JEROME
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:26 N MILLBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1812
Mailing Address - Country:US
Mailing Address - Phone:610-931-3312
Mailing Address - Fax:
Practice Address - Street 1:26 N MILLBOURNE AVE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1812
Practice Address - Country:US
Practice Address - Phone:610-931-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0255441041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical