Provider Demographics
NPI:1326316399
Name:GREENE JACKSON, ALLISON MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MICHELLE
Last Name:GREENE JACKSON
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 1:195 ADAMS ST
Mailing Address - Street 2:APARTMENT 5J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1851
Mailing Address - Country:US
Mailing Address - Phone:347-742-5838
Mailing Address - Fax:
Practice Address - Street 1:406 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7306
Practice Address - Country:US
Practice Address - Phone:347-742-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0782261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical