Provider Demographics
NPI:1588849251
Name:GREENLAW, AMY (MFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GREENLAW
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22505 WOODROE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3410
Mailing Address - Country:US
Mailing Address - Phone:510-318-6112
Mailing Address - Fax:510-569-4589
Practice Address - Street 1:22505 WOODROE AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3410
Practice Address - Country:US
Practice Address - Phone:510-318-6112
Practice Address - Fax:510-569-4589
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA88580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist