Provider Demographics
NPI:1104363068
Name:GREENE, MATTHEW ((MS))
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:(MS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12587 W GENTLE RAIN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7226
Mailing Address - Country:US
Mailing Address - Phone:530-209-2142
Mailing Address - Fax:
Practice Address - Street 1:21448 N 75TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-638-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health