Provider Demographics
NPI:1275760134
Name:GREENEN, KATHRYN MARY (MA)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARY
Last Name:GREENEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 POPLAR CMNS
Mailing Address - Street 2:
Mailing Address - City:DUMMERSTON
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9423
Mailing Address - Country:US
Mailing Address - Phone:802-451-6055
Mailing Address - Fax:
Practice Address - Street 1:1222 PUTNEY RD # 301
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9000
Practice Address - Country:US
Practice Address - Phone:802-451-6055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
100.011498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist