Provider Demographics
NPI:1144374000
Name:GRIFFIN, STEFANIE (PHD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PINECREST LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3112
Mailing Address - Country:US
Mailing Address - Phone:603-496-3399
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST STE 4144
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2236
Practice Address - Country:US
Practice Address - Phone:603-740-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1026103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE744101OtherMEDICARE PTAN
NH3083123Medicaid