Provider Demographics
NPI:1538284047
Name:GREANEY, KERRY ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:ANNE
Last Name:GREANEY
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 1:116 BROWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762
Mailing Address - Country:US
Mailing Address - Phone:732-449-8690
Mailing Address - Fax:
Practice Address - Street 1:200 ATLANTIC AVENUE
Practice Address - Street 2:SUITE K
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-292-0388
Practice Address - Fax:732-292-0399
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC01274000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
183593Medicare ID - Type Unspecified