Healthcare Provider Details

I. General information

NPI: 1679253181
Provider Name (Legal Business Name): GRETA KAESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/30/2023
Certification Date: 07/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 49TH ST
PHILADELPHIA PA
19139-2718
US

IV. Provider business mailing address

414 S 44TH ST APT A4
PHILADELPHIA PA
19104-3923
US

V. Phone/Fax

Practice location:
  • Phone: 215-471-2600
  • Fax:
Mailing address:
  • Phone: 507-261-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW137344
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: