Provider Demographics
NPI:1922386424
Name:GREENE, MARTHA (BRA-S1-8789)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:BRA-S1-8789
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PRICE AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1463
Mailing Address - Country:US
Mailing Address - Phone:650-366-8433
Mailing Address - Fax:650-366-8455
Practice Address - Street 1:609 PRICE AVE
Practice Address - Street 2:STE. 201
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1463
Practice Address - Country:US
Practice Address - Phone:650-366-8433
Practice Address - Fax:650-366-8455
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABRA-S1-8789101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)