Provider Demographics
NPI:1891467346
Name:GREENE, LAWRENCE GERARD
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:GERARD
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 N PENNSYLVANIA AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7585
Mailing Address - Country:US
Mailing Address - Phone:405-747-6878
Mailing Address - Fax:
Practice Address - Street 1:3818 N PENNSYLVANIA AVE APT 203
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7585
Practice Address - Country:US
Practice Address - Phone:405-747-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator