Provider Demographics
NPI:1518386143
Name:GREENE, RAFFEL
Entity Type:Individual
Prefix:
First Name:RAFFEL
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 PERCHING BIRD LN
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2361
Mailing Address - Country:US
Mailing Address - Phone:702-234-8701
Mailing Address - Fax:702-586-6645
Practice Address - Street 1:3528 PERCHING BIRD LN
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2361
Practice Address - Country:US
Practice Address - Phone:702-234-8701
Practice Address - Fax:702-586-6645
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst