Provider Demographics
NPI:1215959598
Name:GREENE, ROBYN LAURIE (MFT)
Entity type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:LAURIE
Last Name:GREENE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TANBARK TER
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3204
Mailing Address - Country:US
Mailing Address - Phone:415-444-5578
Mailing Address - Fax:
Practice Address - Street 1:111 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2330
Practice Address - Country:US
Practice Address - Phone:415-272-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMC 20521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist