Provider Demographics
NPI:1922371566
Name:GREENE, KRISTA ANN (CSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:ANN
Last Name:GREENE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:MALICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:1229 SCENERY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-1942
Mailing Address - Country:US
Mailing Address - Phone:717-796-6550
Mailing Address - Fax:717-796-6551
Practice Address - Street 1:940 WALNUT BOTTOM ROAD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-6926
Practice Address - Country:US
Practice Address - Phone:717-249-0085
Practice Address - Fax:717-249-0647
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126917104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker