Provider Demographics
NPI:1699983668
Name:GRISWOLD, TANIA F (PSYCHOTHERAPIST)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:F
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:F
Other - Last Name:ROVERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:68 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1010
Mailing Address - Country:US
Mailing Address - Phone:617-653-8138
Mailing Address - Fax:
Practice Address - Street 1:68 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PEPPERELL
Practice Address - State:MA
Practice Address - Zip Code:01463-1010
Practice Address - Country:US
Practice Address - Phone:617-653-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301071Medicaid