Provider Demographics
NPI:1407052871
Name:KANOFSKY-GREENE, LYN (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:
Last Name:KANOFSKY-GREENE
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:LYN
Other - Middle Name:K
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLINICAL SOCIAL WORK
Mailing Address - Street 1:11385 DONNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8409
Mailing Address - Country:US
Mailing Address - Phone:678-361-0606
Mailing Address - Fax:
Practice Address - Street 1:11385 DONNINGTON DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8409
Practice Address - Country:US
Practice Address - Phone:678-361-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0037331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical