Provider Demographics
NPI:1821646811
Name:GREENE, THALIA
Entity Type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 135H
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6127
Mailing Address - Country:US
Mailing Address - Phone:978-927-0172
Mailing Address - Fax:978-927-0179
Practice Address - Street 1:100 CUMMINGS CTR STE 135H
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6127
Practice Address - Country:US
Practice Address - Phone:978-927-0172
Practice Address - Fax:978-927-0179
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist