Provider Demographics
NPI:1942659859
Name:GREGO, SHELLE (BSW)
Entity Type:Individual
Prefix:
First Name:SHELLE
Middle Name:
Last Name:GREGO
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GIRARDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17935-1718
Mailing Address - Country:US
Mailing Address - Phone:570-875-2271
Mailing Address - Fax:570-276-2098
Practice Address - Street 1:123 W MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GIRARDVILLE
Practice Address - State:PA
Practice Address - Zip Code:17935-1718
Practice Address - Country:US
Practice Address - Phone:570-875-2271
Practice Address - Fax:570-276-2098
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)