Provider Demographics
NPI:1881995421
Name:GRIFFIN, IAN CLEAENT (LCSW)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:CLEAENT
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 NE 8TH AVE
Mailing Address - Street 2:UNIT 108
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:703-401-4711
Mailing Address - Fax:
Practice Address - Street 1:2725 NE 8TH AVE
Practice Address - Street 2:UNIT 108
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:703-401-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149102921041C0700X
FL168601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical