Healthcare Provider Details

I. General information

NPI: 1497084339
Provider Name (Legal Business Name): NEIL ALLEN GRECO LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 AVON ST N APT 3
SAINT PAUL MN
55103-1356
US

IV. Provider business mailing address

525 PORTLAND AVE # MC963
MINNEAPOLIS MN
55415-1533
US

V. Phone/Fax

Practice location:
  • Phone: 612-888-7809
  • Fax:
Mailing address:
  • Phone: 612-596-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17557
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: