Provider Demographics
NPI:1659740108
Name:MCKENZIE GREENE, NAOMI LEAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:LEAH
Last Name:MCKENZIE GREENE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:867 BOYLSTON ST
Mailing Address - Street 2:5TH FLOOR, SUITE 1717
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2774
Mailing Address - Country:US
Mailing Address - Phone:617-221-3202
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON ST
Practice Address - Street 2:5TH FLOOR, SUITE 1717
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2774
Practice Address - Country:US
Practice Address - Phone:617-221-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X, 390200000X
MA10000097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program