Provider Demographics
NPI:1700902764
Name:GRIFFIN, SUSANNE (PSYD)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 NORTH 16TH STREET
Mailing Address - Street 2:SUITE 219
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5251
Mailing Address - Country:US
Mailing Address - Phone:602-216-6900
Mailing Address - Fax:602-271-9889
Practice Address - Street 1:3550 N CENTRAL AVE STE 1407
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2112
Practice Address - Country:US
Practice Address - Phone:602-216-6900
Practice Address - Fax:602-271-9889
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3663103TH0100X, 103TR0400X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation