Provider Demographics
NPI:1346208667
Name:GRECCO, PATRICK RONALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RONALD
Last Name:GRECCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1725
Mailing Address - Country:US
Mailing Address - Phone:215-242-0900
Mailing Address - Fax:215-242-0912
Practice Address - Street 1:7318 GERMANTOWN AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119
Practice Address - Country:US
Practice Address - Phone:215-242-0900
Practice Address - Fax:215-242-0912
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004927L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR796827OtherMEDICARE ID
506938Medicare UPIN