Provider Demographics
NPI:1124309695
Name:GREER, MELISSA B
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:B
Last Name:GREER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OLD MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3524
Mailing Address - Country:US
Mailing Address - Phone:631-603-8093
Mailing Address - Fax:
Practice Address - Street 1:800 OLD MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3524
Practice Address - Country:US
Practice Address - Phone:631-603-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0880551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical