Provider Demographics
NPI:1740706126
Name:GREC, CAMILLE (MA, LCAT, CH)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:GREC
Suffix:
Gender:M
Credentials:MA, LCAT, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 STATE ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:NY
Mailing Address - Zip Code:12809-3494
Mailing Address - Country:US
Mailing Address - Phone:518-852-8540
Mailing Address - Fax:
Practice Address - Street 1:121 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2483
Practice Address - Country:US
Practice Address - Phone:518-852-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY002052221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor