Provider Demographics
NPI:1205059292
Name:GREENE, SHARON LEE (LCSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6576
Mailing Address - Country:US
Mailing Address - Phone:817-283-6071
Mailing Address - Fax:817-416-0900
Practice Address - Street 1:2401 MUSTANG DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8640
Practice Address - Country:US
Practice Address - Phone:817-481-7474
Practice Address - Fax:817-416-0900
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21599OtherLICENSED CLINICAL SOCIAL