Provider Demographics
NPI:1861654683
Name:GRECO, JESSICA N (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:GRECO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JESSICS
Other - Middle Name:N
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-747-3600
Mailing Address - Fax:802-773-8501
Practice Address - Street 1:12 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4651
Practice Address - Country:US
Practice Address - Phone:802-747-3600
Practice Address - Fax:802-773-8501
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
VT089.01292721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid