Provider Demographics
NPI:1225346141
Name:GREENE, DARCY ROBERT (MA)
Entity Type:Individual
Prefix:MR
First Name:DARCY
Middle Name:ROBERT
Last Name:GREENE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-0234
Mailing Address - Country:US
Mailing Address - Phone:949-306-6386
Mailing Address - Fax:949-203-0418
Practice Address - Street 1:23282 MILL CREEK DR STE 130
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1678
Practice Address - Country:US
Practice Address - Phone:949-415-6383
Practice Address - Fax:949-203-0418
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist