Provider Demographics
NPI:1285861252
Name:GRETEN-GANBERG, DEBRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:GRETEN-GANBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 FORESIDE RD # D
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1759
Mailing Address - Country:US
Mailing Address - Phone:207-221-0727
Mailing Address - Fax:207-221-2755
Practice Address - Street 1:82 FORESIDE RD # D
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1759
Practice Address - Country:US
Practice Address - Phone:207-221-0727
Practice Address - Fax:207-221-2755
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC64871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical