Healthcare Provider Details

I. General information

NPI: 1821328188
Provider Name (Legal Business Name): BARBARA J. GRETEN M.DIV., MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2010
Last Update Date: 07/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BUTTERNUT DR
MERIDEN CT
06450-3509
US

IV. Provider business mailing address

85 BUTTERNUT DR
MERIDEN CT
06450-3509
US

V. Phone/Fax

Practice location:
  • Phone: 203-859-2111
  • Fax: 203-630-1177
Mailing address:
  • Phone: 203-859-2111
  • Fax: 203-630-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007312
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: