Provider Demographics
NPI:1912259300
Name:GRIFFIN, GINA LISA FUGAZZOTTO (MS)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LISA FUGAZZOTTO
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WATERTOWN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2569
Mailing Address - Country:US
Mailing Address - Phone:617-923-7575
Mailing Address - Fax:
Practice Address - Street 1:51 WATERTOWN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2569
Practice Address - Country:US
Practice Address - Phone:617-923-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst