Provider Demographics
NPI:1194907253
Name:GREENE, AMY N (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:GREENE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILLARD LN
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1559
Mailing Address - Country:US
Mailing Address - Phone:978-423-4818
Mailing Address - Fax:781-631-0285
Practice Address - Street 1:10 WILLARD LN
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-1559
Practice Address - Country:US
Practice Address - Phone:978-423-4818
Practice Address - Fax:781-631-0285
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1138211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical