Provider Demographics
NPI:1972727246
Name:GRECO-GREGORY, JUDETH MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDETH
Middle Name:MARIE
Last Name:GRECO-GREGORY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BECK AVE
Mailing Address - Street 2:MS 5-325
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6804
Mailing Address - Country:US
Mailing Address - Phone:707-784-8059
Mailing Address - Fax:707-784-8891
Practice Address - Street 1:275 BECK AVE
Practice Address - Street 2:MS 5-325
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6804
Practice Address - Country:US
Practice Address - Phone:707-784-8059
Practice Address - Fax:707-784-8891
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical