Provider Demographics
NPI:1952020042
Name:NICASIO, GREIDDY
Entity type:Individual
Prefix:
First Name:GREIDDY
Middle Name:
Last Name:NICASIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MAIN ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5927
Mailing Address - Country:US
Mailing Address - Phone:917-728-0012
Mailing Address - Fax:
Practice Address - Street 1:417 MAIN ST APT 2D
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5927
Practice Address - Country:US
Practice Address - Phone:917-728-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty