Basic Information
| Provider Information | |||||||||
| NPI: | 1457796252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIECO | ||||||||
| FirstName: | VANESSA | ||||||||
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| Credential: | PSYD, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19877 E COUNTRY CLUB DR | ||||||||
| Address2: | SUITE 3-108 | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331804812 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1065 NE 125TH ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331615821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058910050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2013 | ||||||||
| LastUpdateDate: | 05/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH10472 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.