Provider Demographics
NPI:1316196231
Name:GREENE, PENNY GALE (MS, NCC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:GALE
Last Name:GREENE
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
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 401
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-0401
Mailing Address - Country:US
Mailing Address - Phone:315-342-2170
Mailing Address - Fax:315-342-2170
Practice Address - Street 1:193 W 1ST ST
Practice Address - Street 2:CANAL COMMONS MALL, LOWER LEVEL
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2586
Practice Address - Country:US
Practice Address - Phone:315-342-2170
Practice Address - Fax:315-342-2170
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health