Provider Demographics
NPI:1669561635
Name:GRECO, CHARLES (LCSW-R,BCD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:GRECO
Suffix:
Gender:M
Credentials:LCSW-R,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JOANN COURT
Mailing Address - Street 2:P.O. 827
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941
Mailing Address - Country:US
Mailing Address - Phone:631-929-1400
Mailing Address - Fax:631-929-1400
Practice Address - Street 1:37 RANDALL RD
Practice Address - Street 2:PO 32
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792
Practice Address - Country:US
Practice Address - Phone:631-929-1400
Practice Address - Fax:631-929-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0227101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical