Provider Demographics
NPI:1225833171
Name:GREENE, NEVAEH SUSAN
Entity type:Individual
Prefix:
First Name:NEVAEH
Middle Name:SUSAN
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 LUPINE DR UNIT 123
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-5338
Mailing Address - Country:US
Mailing Address - Phone:720-862-6070
Mailing Address - Fax:
Practice Address - Street 1:244 LUPINE DR UNIT 123
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-5338
Practice Address - Country:US
Practice Address - Phone:720-862-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician