Provider Demographics
NPI:1205957313
Name:GREENE, LYNETTE M (LCSW)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:M
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 1:6870 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14066-9753
Mailing Address - Country:US
Mailing Address - Phone:716-560-6861
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-1709
Practice Address - Country:US
Practice Address - Phone:585-335-4316
Practice Address - Fax:585-335-3577
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069500-11041C0700X
NY077017-11041C0700X
NY780121041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool