Provider Demographics
NPI:1215000559
Name:GREYTAK, LINDA F (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:F
Last Name:GREYTAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7296 WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9770
Mailing Address - Country:US
Mailing Address - Phone:315-637-1135
Mailing Address - Fax:
Practice Address - Street 1:7296 WAKEFIELD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-9770
Practice Address - Country:US
Practice Address - Phone:315-637-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR012696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54472BMedicare ID - Type Unspecified