Basic Information
| Provider Information | |||||||||
| NPI: | 1841763752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | GRIFFITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 NEW KARNER RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122053854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184311650 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 WATERVLIET SHAKER RD | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121104622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184912758 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2019 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 011284 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.