Healthcare Provider Details

I. General information

NPI: 1336693563
Provider Name (Legal Business Name): DANIEL GREIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 LAKE AVE N
WORCESTER MA
01605-2072
US

IV. Provider business mailing address

425 LAKE AVE N
WORCESTER MA
01605-2072
US

V. Phone/Fax

Practice location:
  • Phone: 617-402-5444
  • Fax:
Mailing address:
  • Phone: 617-402-5444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10000956
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: