Provider Demographics
NPI:1770738890
Name:GRIFFIN, PATRICIA R (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6156
Mailing Address - Country:US
Mailing Address - Phone:855-330-7070
Mailing Address - Fax:718-854-8308
Practice Address - Street 1:11 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1545
Practice Address - Country:US
Practice Address - Phone:855-330-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012720-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical