Provider Demographics
NPI:1841407657
Name:GREENE-WALSH, MARY ANN (MS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:GREENE-WALSH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11414 W CENTER RD
Mailing Address - Street 2:STE 215
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4486
Mailing Address - Country:US
Mailing Address - Phone:402-334-0628
Mailing Address - Fax:402-334-0629
Practice Address - Street 1:11414 W CENTER RD
Practice Address - Street 2:STE 215
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4486
Practice Address - Country:US
Practice Address - Phone:402-334-0628
Practice Address - Fax:402-334-0629
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025337500Medicaid
NE85471OtherBCBS-LMHP