Provider Demographics
NPI:1174514673
Name:SHAMES-DAWSON, GRETA (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:GRETA
Middle Name:
Last Name:SHAMES-DAWSON
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MEADOW AVE
Mailing Address - Street 2:UNIT 20
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1062
Mailing Address - Country:US
Mailing Address - Phone:732-222-9711
Mailing Address - Fax:732-222-9711
Practice Address - Street 1:25 MEADOW AVE
Practice Address - Street 2:UNIT 20
Practice Address - City:MONMOUTH BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07750-1062
Practice Address - Country:US
Practice Address - Phone:732-222-9711
Practice Address - Fax:732-222-9711
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006543001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ767374Medicare ID - Type Unspecified