MEDICARE: MISS TIFFANY MARIE GRECO LCSW

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	3889	OK

General Provider Information

NPI Number	:	1790918720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TIFFANY MARIE GRECO LCSW

Provider Business Mailing Address
First Line	:	1516 S BOSTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-4003
Country	:	US
Telephone Number	:	918-561-6000
Fax Number	:	918-561-6001

Provider Business Practice Location Address
First Line	:	1516 S BOSTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-4003
Country	:	US
Telephone Number	:	918-561-6000
Fax Number	:	918-561-6001

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

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	01/14/2010

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