Provider Demographics
NPI:1023307444
Name:GREENE, MONICA LYNNE (PHD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNNE
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 1:1300 MERCANTILE LN
Mailing Address - Street 2:STE 139 C
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:301-322-2118
Mailing Address - Fax:301-322-2377
Practice Address - Street 1:7905 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3329
Practice Address - Country:US
Practice Address - Phone:240-304-0307
Practice Address - Fax:301-322-2377
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03445103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling