Provider Demographics
NPI:1295377315
Name:GREENE, LINDA ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ALEXANDRA
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3831
Mailing Address - Country:US
Mailing Address - Phone:860-416-7056
Mailing Address - Fax:
Practice Address - Street 1:125 BOSTON POST RD STE 1
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2841
Practice Address - Country:US
Practice Address - Phone:860-917-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0074651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty