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General NPI Number Information
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NPI Number | 1205409828
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Entity Type | Individual
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Provider Name | MR. LUKAS MAVERICK GREYSON
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Gender | Male
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 275 7TH AVE FL 12
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City | NEW YORK
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State | NY
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Zip | 10001-6756
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Country | US
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Telephone | 212-604-1730
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Fax |
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Provider Business Mailing Address
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Address Line | 40 WYCKOFF ST APT 4
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City | BROOKLYN
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State | NY
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Zip | 11201-6345
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Country | US
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Telephone | 917-586-4563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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