Provider Demographics
NPI:1225050388
Name:GREENE, RICHARD M JR (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:GREENE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6220
Mailing Address - Country:US
Mailing Address - Phone:760-721-1111
Mailing Address - Fax:760-721-1116
Practice Address - Street 1:2181 S EL CAMINO REAL
Practice Address - Street 2:SUITE 201
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6220
Practice Address - Country:US
Practice Address - Phone:760-721-1111
Practice Address - Fax:760-721-1116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP7997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPJ0079971Medicaid
CAPJ0079971Medicaid