Provider Demographics
NPI:1295286060
Name:GREENE, YOLETTE JEANTY (LCSW)
Entity type:Individual
Prefix:
First Name:YOLETTE
Middle Name:JEANTY
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YOLETTE
Other - Middle Name:
Other - Last Name:JEANTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:20 HAMILTON PL
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1915
Mailing Address - Country:US
Mailing Address - Phone:718-607-7355
Mailing Address - Fax:
Practice Address - Street 1:40 CAMP RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3744
Practice Address - Country:US
Practice Address - Phone:718-607-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098559-1104100000X
NY0968611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker