Provider Demographics
NPI:1255397626
Name:GREENE, CARROLL H III (PHD)
Entity type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:H
Last Name:GREENE
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 CASSOWARY LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-7170
Mailing Address - Country:US
Mailing Address - Phone:252-288-4681
Mailing Address - Fax:
Practice Address - Street 1:6017 CASSOWARY LN
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-7170
Practice Address - Country:US
Practice Address - Phone:252-288-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001484103TC0700X
FLPY 5282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical