MEDICARE: DR. EILEEN SPILLANE-GRIECO PHD,DSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00388000	NJ

General Provider Information

NPI Number	:	1366591653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EILEEN SPILLANE-GRIECO PHD,DSW

Provider Business Mailing Address
First Line	:	2530 ALGONKIN TRL
Second Line	:
City	:	MANASQUAN
State	:	NJ
Zip	:	08736-2051
Country	:	US
Telephone Number	:	732-449-0126
Fax Number	:	732-449-0126

Provider Business Practice Location Address
First Line	:	215 MORRIS AVE
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-1360
Country	:	US
Telephone Number	:	732-449-0126
Fax Number	:	732-449-0126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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