MEDICARE: JON MICHAEL GREASER LCSW

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	SW 7656	FL

General Provider Information

NPI Number	:	1447667282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON MICHAEL GREASER LCSW

Provider Business Mailing Address
First Line	:	6938 W LINEBAUGH AVE STE 101
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-5824
Country	:	US
Telephone Number	:	813-391-3528
Fax Number	:	813-769-9348

Provider Business Practice Location Address
First Line	:	6938 W LINEBAUGH AVE STE 101
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-5824
Country	:	US
Telephone Number	:	813-391-3528
Fax Number	:	813-769-9348

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	03/17/2018

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