Provider Demographics
NPI:1346579380
Name:GREENE, REBECCA SAMARA (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SAMARA
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6501
Mailing Address - Country:US
Mailing Address - Phone:716-626-9016
Mailing Address - Fax:716-626-4271
Practice Address - Street 1:21 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6501
Practice Address - Country:US
Practice Address - Phone:716-626-9016
Practice Address - Fax:716-626-4271
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR07476411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical