Provider Demographics
NPI:1679733257
Name:GREENE, BEVERLY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN
Last Name:GREENE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 SAINT JOHNS PL
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3240
Mailing Address - Country:US
Mailing Address - Phone:718-638-6451
Mailing Address - Fax:718-230-7125
Practice Address - Street 1:26 SAINT JOHNS PL
Practice Address - Street 2:#3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3240
Practice Address - Country:US
Practice Address - Phone:718-638-6451
Practice Address - Fax:718-230-7125
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7973103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical