Provider Demographics
NPI:1336859958
Name:GRECO, VANESSA J (LMFT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:GRECO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4536 RINETTI LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3311
Mailing Address - Country:US
Mailing Address - Phone:951-640-5386
Mailing Address - Fax:
Practice Address - Street 1:4536 RINETTI LN
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3311
Practice Address - Country:US
Practice Address - Phone:951-640-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist