Provider Demographics
NPI:1275680217
Name:GREENE, SUSAN R (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:GREENE
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1801 BUSH ST
Mailing Address - Street 2:#207
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5239
Mailing Address - Country:US
Mailing Address - Phone:415-441-2789
Mailing Address - Fax:815-717-7625
Practice Address - Street 1:1801 BUSH ST
Practice Address - Street 2:#207
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5239
Practice Address - Country:US
Practice Address - Phone:415-441-2789
Practice Address - Fax:815-717-7625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY19152103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL191520Medicare PIN