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NPI Code Detail

MEDICARE: LAURIE A. GRECO PHD

MEDICARE: LAURIE A. GRECO 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
1103T00000XPsychologist6459OH
2103TC0700XClinical Psychologist6459OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396908133
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE A. GRECO PHD
Provider Business Mailing Address
First Line : 700 ACKERMAN RD STE 2120
Second Line :
City : COLUMBUS
State : OH
Zip : 43202-1559
Country : US
Telephone Number : 614-293-2700
Fax Number :
Provider Business Practice Location Address
First Line : 2231 N HIGH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43201-1194
Country : US
Telephone Number : 614-293-2700
Fax Number : 614-293-2720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2008
Last Update Date : 12/28/2020

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