MEDICARE: DR. GRETA SHAMES-DAWSON LCSW., PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00654300	NJ

General Provider Information

NPI Number	:	1174514673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETA SHAMES-DAWSON LCSW., PHD

Provider Business Mailing Address
First Line	:	25 MEADOW AVE
Second Line	:	UNIT 20
City	:	MONMOUTH BEACH
State	:	NJ
Zip	:	07750-1062
Country	:	US
Telephone Number	:	732-222-9711
Fax Number	:	732-222-9711

Provider Business Practice Location Address
First Line	:	25 MEADOW AVE
Second Line	:	UNIT 20
City	:	MONMOUTH BEACH
State	:	NJ
Zip	:	07750-1062
Country	:	US
Telephone Number	:	732-222-9711
Fax Number	:	732-222-9711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/08/2007

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