Provider Demographics
NPI:1063186583
Name:GRECO, CHERICE (PSY S)
Entity type:Individual
Prefix:
First Name:CHERICE
Middle Name:
Last Name:GRECO
Suffix:
Gender:F
Credentials:PSY S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18546 BITTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2740
Mailing Address - Country:US
Mailing Address - Phone:813-767-5310
Mailing Address - Fax:
Practice Address - Street 1:205 S HOOVER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3533
Practice Address - Country:US
Practice Address - Phone:813-603-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1562103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool