Provider Demographics
NPI:1902011042
Name:GRECO, KARINA EBE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KARINA
Middle Name:EBE
Last Name:GRECO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 NE 31ST CT
Mailing Address - Street 2:#1907
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2655
Mailing Address - Country:US
Mailing Address - Phone:305-466-7121
Mailing Address - Fax:305-466-7121
Practice Address - Street 1:9380 SW 72 ST
Practice Address - Street 2:#22
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5454
Practice Address - Country:US
Practice Address - Phone:305-274-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH 805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL--Medicaid