Provider Demographics
NPI:1023603388
Name:TEITEL-GREENE, MERRIE SUSAN (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:MS
First Name:MERRIE
Middle Name:SUSAN
Last Name:TEITEL-GREENE
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BEDFORD RD # APTC12
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-2740
Mailing Address - Country:US
Mailing Address - Phone:914-953-3731
Mailing Address - Fax:
Practice Address - Street 1:36 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2800
Practice Address - Country:US
Practice Address - Phone:914-810-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0900041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical