Provider Demographics
NPI:1467715060
Name:GREENE, KIM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:GREENE
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 1:6011 N BAYSHORE DR
Mailing Address - Street 2:SUITE #12
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2365
Mailing Address - Country:US
Mailing Address - Phone:305-323-1957
Mailing Address - Fax:305-667-9135
Practice Address - Street 1:6011 N BAYSHORE DR
Practice Address - Street 2:SUITE #12
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2365
Practice Address - Country:US
Practice Address - Phone:305-323-1957
Practice Address - Fax:305-667-9135
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW000011841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical