Provider Demographics
NPI:1417027178
Name:MARINA A. GRECO, PLLC
Entity Type:Organization
Organization Name:MARINA A. GRECO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:602-920-1222
Mailing Address - Street 1:3429 E WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7235
Mailing Address - Country:US
Mailing Address - Phone:602-920-1222
Mailing Address - Fax:
Practice Address - Street 1:2345 E THOMAS RD
Practice Address - Street 2:SUITE 385
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7848
Practice Address - Country:US
Practice Address - Phone:602-955-3429
Practice Address - Fax:602-955-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC2159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1013087006OtherINDIVIDUAL NPI #
AZ831992OtherAHCCCS PROVIDER #