Provider Demographics
NPI:1356745012
Name:GREENE, JADE S (BCBA)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:S
Last Name:GREENE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:S
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 WELLS RD STE 15
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2374
Mailing Address - Country:US
Mailing Address - Phone:904-412-8542
Mailing Address - Fax:
Practice Address - Street 1:1700 WELLS RD STE 15
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2374
Practice Address - Country:US
Practice Address - Phone:904-412-8542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115284100Medicaid