Provider Demographics
NPI:1699865907
Name:GREKIN, STEPHEN C (LCSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:C
Last Name:GREKIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2811
Mailing Address - Country:US
Mailing Address - Phone:607-772-8579
Mailing Address - Fax:
Practice Address - Street 1:84 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2811
Practice Address - Country:US
Practice Address - Phone:607-772-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR005116-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18320OtherMANAGED HEALTH NETWORK
NY10048758OtherCDPHP
NY110753OtherVALUEOPTIONS
NY005116PROtherLCSW
NY119012OtherBHN
NY7403920OtherGHI
NY7223048OtherAETNA
NY7403920OtherGHI
NYCC3579Medicare ID - Type Unspecified