Provider Demographics
NPI:1083921621
Name:GREENE, LORA L (MA)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:L
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:L
Other - Last Name:NUTBROWN-GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:3020 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2814
Mailing Address - Country:US
Mailing Address - Phone:716-831-1800
Mailing Address - Fax:716-831-1818
Practice Address - Street 1:314 ELLICOTT ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3650
Practice Address - Country:US
Practice Address - Phone:585-815-0247
Practice Address - Fax:585-815-0251
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)