Provider Demographics
NPI:1164931036
Name:MOREJON, GRETER
Entity Type:Individual
Prefix:
First Name:GRETER
Middle Name:
Last Name:MOREJON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 SW 210TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-4007
Mailing Address - Country:US
Mailing Address - Phone:305-984-3736
Mailing Address - Fax:
Practice Address - Street 1:8000 SW 210TH ST APT 210
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-4007
Practice Address - Country:US
Practice Address - Phone:305-984-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty