Provider Demographics
NPI:1801289905
Name:GREENE, DIANNE L W (MA, MFT)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:L W
Last Name:GREENE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 260692
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426
Mailing Address - Country:US
Mailing Address - Phone:818-569-3040
Mailing Address - Fax:
Practice Address - Street 1:23480 PARK SORRENTO STE 209A
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1359
Practice Address - Country:US
Practice Address - Phone:818-569-3040
Practice Address - Fax:888-971-3942
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80619...............106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist