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General NPI Number Information
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NPI Number | 1639698673
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Entity Type | Organization
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Legal Business Name | CHERYL GREZLIK, LCSW, LLC
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 09/11/2017
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Provider Practice Location Address
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Address Line | 710 MAIN ST BLDG 1
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City | PLANTSVILLE
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State | CT
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Zip | 06479-1568
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Country | US
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Telephone | 860-324-4787
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 WOODRUFF ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2955
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, LCSW
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Name | CHERYL GREZLIK
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Credential | LCSW
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Telephone | 860-324-4787
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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 | 006435
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License Number State | CT
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