Provider Demographics
NPI:1689909111
Name:GREENE, ELIZABETH RUDD (MSW, JD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUDD
Last Name:GREENE
Suffix:
Gender:F
Credentials:MSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1019
Mailing Address - Country:US
Mailing Address - Phone:410-263-1100
Mailing Address - Fax:
Practice Address - Street 1:1616 FOREST DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1019
Practice Address - Country:US
Practice Address - Phone:410-263-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical