Provider Demographics
NPI:1700939485
Name:GRECCO, NINA C (LCSW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:C
Last Name:GRECCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 QUARRY HALL RD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4543
Mailing Address - Country:US
Mailing Address - Phone:215-237-7671
Mailing Address - Fax:
Practice Address - Street 1:708 S BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5845
Practice Address - Country:US
Practice Address - Phone:215-237-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2017-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2141096000OtherINDEPENDENCE BLUE CROSS
PA7911488OtherAETNA
PAGR1455749OtherHIGHMARK FEP
PAGR1455749OtherHIGHMARK FEP
PAP91962Medicare UPIN