Provider Demographics
NPI:1316161821
Name:GREEN-HENNESSY, SHARON JENNY (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JENNY
Last Name:GREEN-HENNESSY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 N CHARLES ST
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY LOYOLA COLLEGE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2601
Mailing Address - Country:US
Mailing Address - Phone:410-617-2641
Mailing Address - Fax:
Practice Address - Street 1:5911 YORK RD
Practice Address - Street 2:SUITE 100 LOYOLA CLINICAL CENTERS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3048
Practice Address - Country:US
Practice Address - Phone:410-617-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3251103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent