Provider Demographics
NPI:1013927664
Name:GREENE, SUZANNE DARLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:DARLENE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 3022
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730
Mailing Address - Country:US
Mailing Address - Phone:207-649-4047
Mailing Address - Fax:605-673-3902
Practice Address - Street 1:810 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2520
Practice Address - Country:US
Practice Address - Phone:605-791-4665
Practice Address - Fax:605-791-4666
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD31781041C0700X
MELC79591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1013927664Medicaid