Provider Demographics
NPI:1154048601
Name:GREENE, EMILY FAITH
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:FAITH
Last Name:GREENE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:FAITH
Other - Last Name:COLVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8001 BEATY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1602
Mailing Address - Country:US
Mailing Address - Phone:813-926-5454
Mailing Address - Fax:
Practice Address - Street 1:11476 S APOPKA VINELAND RD STE 118
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-7006
Practice Address - Country:US
Practice Address - Phone:407-955-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-247651106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician