Provider Demographics
NPI:1801146956
Name:CORTEZ-GREIG, SHANTA PALOMA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHANTA
Middle Name:PALOMA
Last Name:CORTEZ-GREIG
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 1:20 ELM CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-9746
Mailing Address - Country:US
Mailing Address - Phone:413-337-7317
Mailing Address - Fax:
Practice Address - Street 1:20 ELM CIR
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9746
Practice Address - Country:US
Practice Address - Phone:413-337-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1210461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid