Provider Demographics
NPI:1144520479
Name:GRISWOLD, EMILY A (LMSW)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:A
Last Name:GRISWOLD
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 1:215 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2113
Mailing Address - Country:US
Mailing Address - Phone:315-472-4404
Mailing Address - Fax:
Practice Address - Street 1:215 BASSETT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2113
Practice Address - Country:US
Practice Address - Phone:315-472-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082450104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker