Robert Edward Griffin, PSYCHOLOGIST

Individual provider Active NPI Psychologist · Forty Fort, PA

NPI 1194841247 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1194841247
Entity type
Individual (NPI type 1)
Primary specialty
Psychologist 103T00000X
License
PS-005508-L (PA)
Practice address
100 River St
Forty Fort, PA 18704-5067
Phone
(570) 287-7570
Fax
(570) 287-7570
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
PS-005508-LPAMDPsychologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS-005508-L PA Yes

Addresses

Primary practice location

100 River St
Forty Fort, PA 18704-5067

Mailing address

100 River St
Forty Fort, PA 18704-5067
Phone (570) 287-7570

Other providers in Forty Fort, PA

All providers in Forty Fort, PA · Psychologist in Pennsylvania

Sources for this page

Verify at the official NPI Registry.