Provider Demographics
NPI:1356083653
Name:GRELECKI, JESSICA RENEE (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:GRELECKI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SOUTH ST UNIT 34
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2137
Mailing Address - Country:US
Mailing Address - Phone:415-517-2914
Mailing Address - Fax:
Practice Address - Street 1:41 SOUTH ST UNIT 34
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2137
Practice Address - Country:US
Practice Address - Phone:415-517-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist