Provider Demographics
NPI:1326060864
Name:GREENE, ROBERT E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:GREENE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8004
Mailing Address - Country:US
Mailing Address - Phone:727-343-2277
Mailing Address - Fax:727-302-0207
Practice Address - Street 1:5440 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8004
Practice Address - Country:US
Practice Address - Phone:727-343-2277
Practice Address - Fax:727-302-0207
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110280OtherCOMPSYCH
FLZ3563OtherBLUE SHIELD OF FLORIDA
FLZ3563OtherBLUE SHIELD OF FLORIDA