Provider Demographics
NPI:1184065492
Name:GREENE, SUSAN MICHELLE (MA, MFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MICHELLE
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14064 SOSNA WAY
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-9590
Mailing Address - Country:US
Mailing Address - Phone:707-604-6943
Mailing Address - Fax:
Practice Address - Street 1:8911 LAKEWOOD DR
Practice Address - Street 2:SUITE 24D
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7856
Practice Address - Country:US
Practice Address - Phone:707-604-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist