Provider Demographics
NPI:1497945034
Name:GREENE HENDERSON, LISA MELLISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MELLISA
Last Name:GREENE HENDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:5100 AUTH WAY
Practice Address - Street 2:KAISER PERMANENTE MARLOW HEIGHTS MEDICAL CENTER
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4207
Practice Address - Country:US
Practice Address - Phone:301-702-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000375103TC0700X
MD04392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical