Provider Demographics
NPI:1720141369
Name:GREENE, AMY LARSSON (MA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LARSSON
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1515
Mailing Address - Country:US
Mailing Address - Phone:617-964-5326
Mailing Address - Fax:617-964-5326
Practice Address - Street 1:24 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1524
Practice Address - Country:US
Practice Address - Phone:617-964-5326
Practice Address - Fax:617-964-5326
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10256101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical