Provider Demographics
NPI:1780498758
Name:GREENMAN, MIMI NANETTE (LCSW-R, MPH)
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:NANETTE
Last Name:GREENMAN
Suffix:
Gender:F
Credentials:LCSW-R, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 COACHLIGHT SQ
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548-1252
Mailing Address - Country:US
Mailing Address - Phone:914-815-3414
Mailing Address - Fax:
Practice Address - Street 1:217 COACHLIGHT SQ
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1252
Practice Address - Country:US
Practice Address - Phone:914-815-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028162-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical