Provider Demographics
NPI:1497717599
Name:GREENE, STEFAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:STEFAN
Other - Middle Name:EDWARD
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4442
Mailing Address - Country:US
Mailing Address - Phone:415-892-8311
Mailing Address - Fax:415-897-1488
Practice Address - Street 1:4 TRUMAN DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4442
Practice Address - Country:US
Practice Address - Phone:415-892-8311
Practice Address - Fax:415-897-1488
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS107521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical