Provider Demographics
NPI:1104968114
Name:GREENE, DIANE K (LISW)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:K
Last Name:GREENE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 HIGH STREET-LOWER LEVEL
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085
Mailing Address - Country:US
Mailing Address - Phone:614-430-0727
Mailing Address - Fax:614-846-7466
Practice Address - Street 1:951 HIGH STREET-LOWER LEVEL
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085
Practice Address - Country:US
Practice Address - Phone:614-430-0727
Practice Address - Fax:614-846-7466
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00080821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI0008082OtherL.I.S.W.