Provider Demographics
NPI:1962008227
Name:GREENE, LORI ISMAN (PHD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ISMAN
Last Name:GREENE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 FOXWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2521
Mailing Address - Country:US
Mailing Address - Phone:914-318-5006
Mailing Address - Fax:
Practice Address - Street 1:545 SAW MILL RIVER RD # 3E2
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2157
Practice Address - Country:US
Practice Address - Phone:914-318-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical