Provider Demographics
NPI:1942449954
Name:GREENE, PHYLLIS (MFT, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:MFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 TULARE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2112
Mailing Address - Country:US
Mailing Address - Phone:510-526-5515
Mailing Address - Fax:
Practice Address - Street 1:908 TULARE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94707-2112
Practice Address - Country:US
Practice Address - Phone:510-526-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS54391041C0700X
CAMFT9287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical