MEDICARE: GREATER SELF THERAPEUTIC SERVICES LLC

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

General Provider Information

NPI Number	:	1780339986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER SELF THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	15 SIR THOMAS LN
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19702-4179
Country	:	US
Telephone Number	:	302-249-8224
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 SIR THOMAS LN
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19702-4179
Country	:	US
Telephone Number	:	302-249-8224
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	GREGORY SNEAD
Credential	:	LCSW
Telephone Number	:	302-249-8224

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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