Provider Demographics
NPI:1023981545
Name:TIEZZI-CLARK, GRIFFIN GRANGER
Entity type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:GRANGER
Last Name:TIEZZI-CLARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OLD PROFILE RD
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:NH
Mailing Address - Zip Code:03456-6408
Mailing Address - Country:US
Mailing Address - Phone:475-355-1771
Mailing Address - Fax:
Practice Address - Street 1:348 MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:SWANZEY
Practice Address - State:NH
Practice Address - Zip Code:03446-3500
Practice Address - Country:US
Practice Address - Phone:475-355-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician