Provider Demographics
NPI:1790259208
Name:GREENE, ALICIA LOUISE (LMSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LOUISE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 MERCHANTS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-5442
Mailing Address - Country:US
Mailing Address - Phone:585-245-4783
Mailing Address - Fax:
Practice Address - Street 1:1100 UNIVERSITY AVE STE 113
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1655
Practice Address - Country:US
Practice Address - Phone:585-576-7076
Practice Address - Fax:315-866-3174
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103037-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker