Provider Demographics
NPI:1386784189
Name:GRECO, AMI JO E (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMI JO
Middle Name:E
Last Name:GRECO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:AMI JO
Other - Middle Name:E
Other - Last Name:ARSENAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:67 EUSTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5173
Mailing Address - Country:US
Mailing Address - Phone:207-660-4549
Mailing Address - Fax:207-660-4529
Practice Address - Street 1:66 STONE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5227
Practice Address - Country:US
Practice Address - Phone:207-873-2136
Practice Address - Fax:207-660-4529
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC200681041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432509199Medicaid