Provider Demographics
NPI:1568236594
Name:CASINO, GRETA
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:CASINO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:GRETA
Other - Middle Name:
Other - Last Name:RECINTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:GRETA RECINTO
Mailing Address - Street 1:14112 S KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3018
Mailing Address - Country:US
Mailing Address - Phone:949-342-6793
Mailing Address - Fax:
Practice Address - Street 1:14112 S KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3018
Practice Address - Country:US
Practice Address - Phone:949-342-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1240461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical