Provider Demographics
NPI:1477906725
Name:GREENE, RICHARD A III (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:GREENE
Suffix:III
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 1:407 MAIN ST SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2710
Mailing Address - Country:US
Mailing Address - Phone:406-529-0493
Mailing Address - Fax:
Practice Address - Street 1:407 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864
Practice Address - Country:US
Practice Address - Phone:406-529-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health