Provider Demographics
NPI:1013388867
Name:GRECO, MARISSA (LPC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:GRECO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GLOUCESTER CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1880
Mailing Address - Country:US
Mailing Address - Phone:732-977-3954
Mailing Address - Fax:
Practice Address - Street 1:200 WHITE RD STE 208
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1162
Practice Address - Country:US
Practice Address - Phone:732-977-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00626000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional