1578605945 NPI number — MRS. SALLY D GREIG MSW LCSW

Table of content: MRS. SALLY D GREIG MSW LCSW (NPI 1578605945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578605945 NPI number — MRS. SALLY D GREIG MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREIG
Provider First Name:
SALLY
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578605945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 N CAMDEN DR
Provider Second Line Business Mailing Address:
117
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90210-4410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-569-1305
Provider Business Mailing Address Fax Number:
310-273-8024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 NORTH CAMDEN
Provider Second Line Business Practice Location Address:
117
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-569-1305
Provider Business Practice Location Address Fax Number:
310-273-8024
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  16161 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 16161 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1578605945 . This is a "PTAN:BS168A" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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