Provider Demographics
NPI:1598823569
Name:GREENE, STEPHEN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:S
Last Name:GREENE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PRIEST HILL RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989-3305
Mailing Address - Country:US
Mailing Address - Phone:207-649-4046
Mailing Address - Fax:207-861-7420
Practice Address - Street 1:49 OAK ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5118
Practice Address - Country:US
Practice Address - Phone:207-649-4046
Practice Address - Fax:207-622-6290
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME025902OtherMEDICARE
ME191060100Medicaid