Provider Demographics
NPI:1275372997
Name:GREENE, ALLUCARDO
Entity type:Individual
Prefix:
First Name:ALLUCARDO
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 NE HERITAGE PKWY UNIT 208
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5014
Mailing Address - Country:US
Mailing Address - Phone:406-272-6546
Mailing Address - Fax:
Practice Address - Street 1:10701 NE HERITAGE PKWY UNIT 208
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-5014
Practice Address - Country:US
Practice Address - Phone:406-272-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ORA150191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical