Provider Demographics
NPI:1811921265
Name:GRIFFIN, JEANNE G (PHD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:G
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 JOHN F KENNEDY BLVD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7421
Mailing Address - Country:US
Mailing Address - Phone:215-640-0600
Mailing Address - Fax:215-640-0914
Practice Address - Street 1:1800 JOHN F KENNEDY BLVD
Practice Address - Street 2:SUITE 605
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19103-7421
Practice Address - Country:US
Practice Address - Phone:215-640-0600
Practice Address - Fax:215-640-0914
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003291L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR196871Medicare UPIN