Provider Demographics
NPI:1740318328
Name:GRECO, IRENE SUSAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:SUSAN
Last Name:GRECO
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 1:10 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2004
Mailing Address - Country:US
Mailing Address - Phone:516-623-8588
Mailing Address - Fax:516-623-8588
Practice Address - Street 1:10 CHELSEA DR
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2004
Practice Address - Country:US
Practice Address - Phone:516-623-8588
Practice Address - Fax:516-623-8588
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040306-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN61951Medicare ID - Type Unspecified