Provider Demographics
NPI:1881601003
Name:GREENE, BARBARA RUTH (PHD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:RUTH
Last Name:GREENE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8969 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9515
Mailing Address - Country:US
Mailing Address - Phone:315-655-2579
Mailing Address - Fax:315-655-2579
Practice Address - Street 1:4500 PEWTER LN
Practice Address - Street 2:BUILDING 7
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9707
Practice Address - Country:US
Practice Address - Phone:315-682-2355
Practice Address - Fax:315-655-2579
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical