Provider Demographics
NPI:1750496410
Name:DISY, GREG (MSW-LCSW)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:DISY
Suffix:
Gender:M
Credentials:MSW-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HATCH DR
Mailing Address - Street 2:PO BOX 1018
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2161
Mailing Address - Country:US
Mailing Address - Phone:207-498-6431
Mailing Address - Fax:207-492-3181
Practice Address - Street 1:43 HATCH DR
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2161
Practice Address - Country:US
Practice Address - Phone:207-498-6431
Practice Address - Fax:207-492-3181
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC14781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DI ME0014Medicare ID - Type Unspecified