Provider Demographics
NPI:1871792143
Name:GRIFFIN, IAN LAMAR (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:LAMAR
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MALONEY RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6249
Mailing Address - Country:US
Mailing Address - Phone:347-401-4193
Mailing Address - Fax:845-473-0623
Practice Address - Street 1:131 MALONEY RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6249
Practice Address - Country:US
Practice Address - Phone:347-401-4193
Practice Address - Fax:845-473-0623
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR075942-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical