Provider Demographics
NPI:1356009948
Name:GRETHEL, MICHELE MARIE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:MARIE
Last Name:GRETHEL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:GRETHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW
Mailing Address - Street 1:175 W 87TH ST APT 27H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2910
Mailing Address - Country:US
Mailing Address - Phone:917-476-5024
Mailing Address - Fax:
Practice Address - Street 1:31A W 82ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5601
Practice Address - Country:US
Practice Address - Phone:917-797-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0527801041C0700X
CT58.0054871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical