Provider Demographics
NPI:1073854402
Name:GREENE, ELISE KAREN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:KAREN
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091
Mailing Address - Country:US
Mailing Address - Phone:540-745-4700
Mailing Address - Fax:540-745-4706
Practice Address - Street 1:401 SOUTH LOCUST STREET, STE 102
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091
Practice Address - Country:US
Practice Address - Phone:540-745-4700
Practice Address - Fax:540-745-4706
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040081701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical