Provider Demographics
NPI:1215164405
Name:GREENE, MITCHELL ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ANDREW
Last Name:GREENE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N WAYNE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3542
Mailing Address - Country:US
Mailing Address - Phone:610-875-9435
Mailing Address - Fax:610-975-9851
Practice Address - Street 1:121 N WAYNE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3542
Practice Address - Country:US
Practice Address - Phone:610-875-9435
Practice Address - Fax:610-975-9851
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PWPS008733L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical