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General NPI Number Information
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NPI Number | 1356009948
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Entity Type | Individual
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Provider Name | MICHELE MARIE GRETHEL PHD, LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 31A W 82ND ST
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City | NEW YORK
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State | NY
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Zip | 10024-5601
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Country | US
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Telephone | 917-797-5608
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Fax |
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Provider Business Mailing Address
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Address Line | 175 W 87TH ST APT 27H
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City | NEW YORK
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State | NY
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Zip | 10024-2910
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Country | US
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Telephone | 917-476-5024
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R052780
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 58.005487
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License Number State | CT
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