Doctor Name: | KELLY GRESKO |
NPI Number: | 1063885176 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 44SC05527400 |
Business Practice Address: | 86 S Harrison St East Orange, NJ - 070181748 |
Business Phone Number: | 9733247879 |
Business Fax Number: | |
Mailing Address: | 123 Morris Tpke, RANDOLPH |
State: | NJ |
Postal Code: | 078692931 |
Phone Number: | 7328901483 |
Fax Number: | |
NPI Enumeration Date: | 11/11/2015 |
NPI Last Update Date: | 11/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 44SC05527400 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |