Provider Demographics
NPI:1356697510
Name:STEPHEN GREENE, PH.D. PC
Entity type:Organization
Organization Name:STEPHEN GREENE, PH.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-649-4046
Mailing Address - Street 1:138 PRIEST HILL RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989-3305
Mailing Address - Country:US
Mailing Address - Phone:207-649-4046
Mailing Address - Fax:207-622-6290
Practice Address - Street 1:49 OAK ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5118
Practice Address - Country:US
Practice Address - Phone:207-649-4046
Practice Address - Fax:207-622-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS 1024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0028096Medicare PIN