Provider Demographics
NPI:1902444227
Name:GRIFFITH, STACEY MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MARIE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 JAMES ST STE 240
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2229
Mailing Address - Country:US
Mailing Address - Phone:315-478-2453
Mailing Address - Fax:
Practice Address - Street 1:502 COURT ST STE 210
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4233
Practice Address - Country:US
Practice Address - Phone:315-732-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker