Provider Demographics
NPI:1710112636
Name:CRECER, INC
Entity Type:Organization
Organization Name:CRECER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-888-0215
Mailing Address - Street 1:1335 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4729
Mailing Address - Country:US
Mailing Address - Phone:631-888-0215
Mailing Address - Fax:631-888-0431
Practice Address - Street 1:4610 61ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5766
Practice Address - Country:US
Practice Address - Phone:631-888-0215
Practice Address - Fax:631-888-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075579-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty