Provider Demographics
NPI:1528145133
Name:GRIFFES, DANIEL G (MA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:GRIFFES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-5022
Mailing Address - Country:US
Mailing Address - Phone:802-334-7549
Mailing Address - Fax:704-987-8746
Practice Address - Street 1:194 MAIN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-6104
Practice Address - Country:US
Practice Address - Phone:802-334-7549
Practice Address - Fax:704-987-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2039196OtherCIGNA
VT2633OtherBLUE CROSS BLUE SHIELD
VT0002633Medicaid
VTGR VT2633Medicaid