Provider Demographics
NPI:1972668549
Name:GREENFIELD, LORE ANN (LCSW,CASAC)
Entity Type:Individual
Prefix:MRS
First Name:LORE
Middle Name:ANN
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:LCSW,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TAMARA CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4146
Mailing Address - Country:US
Mailing Address - Phone:631-491-3110
Mailing Address - Fax:
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3975
Practice Address - Country:US
Practice Address - Phone:631-421-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03678511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2M961Medicaid
NYN2M961Medicaid