Provider Demographics
NPI:1811171994
Name:GREENE, MAAYAN (MSW)
Entity type:Individual
Prefix:
First Name:MAAYAN
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MAAYAN
Other - Middle Name:
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:475 WELDON AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1540
Mailing Address - Country:US
Mailing Address - Phone:415-572-3501
Mailing Address - Fax:
Practice Address - Street 1:5625 COLLEGE AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1599
Practice Address - Country:US
Practice Address - Phone:510-463-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical