Provider Demographics
NPI:1760765424
Name:AVERBACH, GRETA (LCSW)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:AVERBACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 FORESIDE RD APT D
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1759
Mailing Address - Country:US
Mailing Address - Phone:207-747-8665
Mailing Address - Fax:
Practice Address - Street 1:257 DEERING AVE STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4858
Practice Address - Country:US
Practice Address - Phone:207-747-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC153411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical