Provider Demographics
NPI:1538894159
Name:GRIFFITH, CORISSA LAURALANE (LCSW)
Entity type:Individual
Prefix:
First Name:CORISSA
Middle Name:LAURALANE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822A E HOMER ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1875
Mailing Address - Country:US
Mailing Address - Phone:262-949-9396
Mailing Address - Fax:
Practice Address - Street 1:619 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3839
Practice Address - Country:US
Practice Address - Phone:414-277-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11625-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical