Provider Demographics
NPI:1013087006
Name:GRECO, MARINA A (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:A
Last Name:GRECO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 E WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7235
Mailing Address - Country:US
Mailing Address - Phone:602-920-1222
Mailing Address - Fax:
Practice Address - Street 1:2345 E THOMAS RD
Practice Address - Street 2:SUITE # 385
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7848
Practice Address - Country:US
Practice Address - Phone:602-955-3429
Practice Address - Fax:602-955-3430
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC2159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831992OtherAHCCCS PROVIDER #