Provider Demographics
NPI:1376667352
Name:GREIG, KATHERINE MARIE (LISW)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARIE
Last Name:GREIG
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 SHAKER BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1931
Mailing Address - Country:US
Mailing Address - Phone:216-791-0910
Mailing Address - Fax:216-273-7678
Practice Address - Street 1:11811 SHAKER BLVD STE 306
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1931
Practice Address - Country:US
Practice Address - Phone:216-791-0910
Practice Address - Fax:216-273-7678
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00093431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH378320OtherPTAN
OHPRN2746294Medicaid