Provider Demographics
NPI:1235492984
Name:GREFER, CHARLES R (LMHC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:GREFER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7475 MORGAN RD
Mailing Address - Street 2:7-2
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3921
Mailing Address - Country:US
Mailing Address - Phone:315-744-4388
Mailing Address - Fax:
Practice Address - Street 1:7475 MORGAN RD
Practice Address - Street 2:7-2
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3921
Practice Address - Country:US
Practice Address - Phone:315-744-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001258101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 102L00000X, 103TC1900X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$Medicaid