Provider Demographics
NPI:1740683978
Name:GREENE, BETHANY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7239 CREIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4270
Mailing Address - Country:US
Mailing Address - Phone:804-461-6012
Mailing Address - Fax:
Practice Address - Street 1:7239 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4270
Practice Address - Country:US
Practice Address - Phone:804-461-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA0133002273103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty