Provider Demographics
NPI:1033971726
Name:GREENE, BILLOAH A (ACSW)
Entity Type:Individual
Prefix:
First Name:BILLOAH
Middle Name:A
Last Name:GREENE
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14431 VENTURA BLVD STE 357
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2606
Mailing Address - Country:US
Mailing Address - Phone:310-721-1430
Mailing Address - Fax:
Practice Address - Street 1:9710 ZELZAH AVE # B204
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4722
Practice Address - Country:US
Practice Address - Phone:310-721-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1201001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical