Provider Demographics
NPI:1790406171
Name:WAAG, GRETA
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:WAAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SEA VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NAHANT
Mailing Address - State:MA
Mailing Address - Zip Code:01908-1531
Mailing Address - Country:US
Mailing Address - Phone:203-733-2850
Mailing Address - Fax:
Practice Address - Street 1:95 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1524
Practice Address - Country:US
Practice Address - Phone:203-733-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health