Provider Demographics
NPI:1972671675
Name:GREENE, BRENDA IRENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:IRENE
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 1:234 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-4106
Mailing Address - Country:US
Mailing Address - Phone:315-514-1785
Mailing Address - Fax:315-514-1785
Practice Address - Street 1:234 RIVER DR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-4106
Practice Address - Country:US
Practice Address - Phone:315-514-1785
Practice Address - Fax:315-514-1785
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009780103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2099638OtherCIGNA BEHAVIORAL HEALTH
NY6804763OtherVALUE OPTIONS GHI
MN2099638OtherCIGNA BEHAVIORAL HEALTH