Provider Demographics
NPI:1609853969
Name:GRIFO, LORI R (PSYD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:R
Last Name:GRIFO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 N WESTERN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2181
Mailing Address - Country:US
Mailing Address - Phone:773-698-8400
Mailing Address - Fax:
Practice Address - Street 1:4633 N WESTERN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2181
Practice Address - Country:US
Practice Address - Phone:773-698-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006558103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK08520Medicare UPIN
IL209563Medicare ID - Type Unspecified