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General NPI Number Information
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NPI Number | 1497084339
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Entity Type | Individual
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Provider Name | NEIL ALLEN GRECO LICSW
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Gender | Male
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 965 AVON ST N APT 3
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City | SAINT PAUL
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State | MN
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Zip | 55103-1356
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Country | US
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Telephone | 612-888-7809
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Fax |
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Provider Business Mailing Address
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Address Line | 525 PORTLAND AVE # MC963
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1533
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Country | US
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Telephone | 612-596-1223
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17557
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License Number State | MN
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