MEDICARE: ALISSA GREN LICSW

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	DP00944107	WV

General Provider Information

NPI Number	:	1497128417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA GREN LICSW

Provider Business Mailing Address
First Line	:	235 HIGH ST STE 819
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-5448
Country	:	US
Telephone Number	:	304-202-1950
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 HIGH ST STE 819
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-5448
Country	:	US
Telephone Number	:	304-202-1950
Fax Number	:

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

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	11/25/2024

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Directions to “ ALISSA GREN LICSW” Practice Location

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