Provider Demographics
NPI:1215077136
Name:GREENE, JILL CHRISTINE (R-LCSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CHRISTINE
Last Name:GREENE
Suffix:
Gender:F
Credentials:R-LCSW
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CHRISTINE
Other - Last Name:SLATERPRYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R-LCSW
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:ROARING BROOK RANCH
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-0671
Mailing Address - Country:US
Mailing Address - Phone:518-796-5478
Mailing Address - Fax:
Practice Address - Street 1:2206 STATE ROUTE 9N
Practice Address - Street 2:ROARING BROOK RANCH
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-0671
Practice Address - Country:US
Practice Address - Phone:518-796-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0609361104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker