Provider Demographics
NPI:1780375683
Name:LAURA M GREENE LICENSED BEHAVIOR ANALYST, PLLC
Entity type:Organization
Organization Name:LAURA M GREENE LICENSED BEHAVIOR ANALYST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LBA
Authorized Official - Phone:516-395-0806
Mailing Address - Street 1:5 CLAY CT
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-2500
Mailing Address - Country:US
Mailing Address - Phone:845-204-8738
Mailing Address - Fax:
Practice Address - Street 1:5 CLAY CT
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-2500
Practice Address - Country:US
Practice Address - Phone:516-395-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty