MEDICARE: JAMIE NICOLE GREER CSW

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	258174	KY

General Provider Information

NPI Number	:	1194404699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE NICOLE GREER CSW

Provider Business Mailing Address
First Line	:	PO BOX 154
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40588-0154
Country	:	US
Telephone Number	:	502-727-0787
Fax Number	:

Provider Business Practice Location Address
First Line	:	3493 LANSDOWNE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1147
Country	:	US
Telephone Number	:	859-396-8723
Fax Number	:

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

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/13/2023

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