Provider Demographics
NPI:1164315651
Name:GRECO, MICHELLE ANTOINETTE (LAC, NCC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:GRECO
Suffix:
Gender:F
Credentials:LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 CONSTITUTION WAY
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-4535
Mailing Address - Country:US
Mailing Address - Phone:732-272-5492
Mailing Address - Fax:
Practice Address - Street 1:750 BROAD ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4230
Practice Address - Country:US
Practice Address - Phone:848-353-0187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00848800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health