Provider Demographics
NPI:1932567146
Name:GREENE, AMY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10410 KENSINGTON PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2938
Mailing Address - Country:US
Mailing Address - Phone:301-789-2282
Mailing Address - Fax:
Practice Address - Street 1:10410 KENSINGTON PKWY STE 303
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2938
Practice Address - Country:US
Practice Address - Phone:301-789-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC20000025661041C0700X
MD188191041C0700X
TX1095001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical