Provider Demographics
NPI:1043878564
Name:GREENE, JOEL III (MS)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:GREENE
Suffix:III
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3263
Mailing Address - Country:US
Mailing Address - Phone:337-446-4707
Mailing Address - Fax:
Practice Address - Street 1:2701 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3263
Practice Address - Country:US
Practice Address - Phone:337-446-4707
Practice Address - Fax:337-446-4715
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator