Provider Demographics
NPI:1164820742
Name:GREENE, SAMANTHA (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
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 1:400 CHISHOLM PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6938
Mailing Address - Country:US
Mailing Address - Phone:972-424-2300
Mailing Address - Fax:
Practice Address - Street 1:2600 K AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5306
Practice Address - Country:US
Practice Address - Phone:972-423-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX557261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical