Provider Demographics
NPI:1952069635
Name:GREENE, CLAUDE JR (LCSW)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:
Last Name:GREENE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 CLARK AVE APT 75
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4055
Mailing Address - Country:US
Mailing Address - Phone:203-535-7350
Mailing Address - Fax:
Practice Address - Street 1:38 KELLEY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5715
Practice Address - Country:US
Practice Address - Phone:860-314-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT118501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical