Provider Demographics
NPI:1033292347
Name:GREENE, LORI ELLEN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELLEN
Last Name:GREENE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BOB WALKER RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4457
Mailing Address - Country:US
Mailing Address - Phone:423-753-3871
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF SIDNEY AND LAMONT STREET
Practice Address - Street 2:BUILDING 161, NHCU-2
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3437
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5528104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker