Provider Demographics
NPI:1568072619
Name:GREENE, DAVID J (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GREENE
Suffix:
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 1:7 ELY PL
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3005
Mailing Address - Country:US
Mailing Address - Phone:917-936-6288
Mailing Address - Fax:
Practice Address - Street 1:7 BARLOW RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3022
Practice Address - Country:US
Practice Address - Phone:732-535-7343
Practice Address - Fax:732-503-8962
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059352001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical