Provider Demographics
NPI:1275720237
Name:GREENE, COLLEEN (LCMHC, CAP)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCMHC, CAP
Other - Prefix:
Other - First Name:COLLEN
Other - Middle Name:
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:560 VILLAGE BLVD 150
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1961
Mailing Address - Country:US
Mailing Address - Phone:561-331-8800
Mailing Address - Fax:561-331-8074
Practice Address - Street 1:518 SW PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8734
Practice Address - Country:US
Practice Address - Phone:561-818-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10435101YM0800X
FL4863101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)