Provider Demographics
NPI:1174666408
Name:GREENE, GERALDINE MARIE (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MARIE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541
Mailing Address - Country:US
Mailing Address - Phone:845-628-7629
Mailing Address - Fax:845-621-1541
Practice Address - Street 1:854 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541
Practice Address - Country:US
Practice Address - Phone:845-628-7629
Practice Address - Fax:845-621-1541
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0087341104100000X
PASW124759104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
164658OtherMHN INS
4342682OtherAETNA INS
N04212Medicare ID - Type Unspecified