Provider Demographics
NPI:1386781029
Name:GREENE, EUDICE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:EUDICE
Middle Name:ANN
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:908 TULARE AVE.
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2112
Mailing Address - Country:US
Mailing Address - Phone:510-524-0566
Mailing Address - Fax:
Practice Address - Street 1:908 TULARE AVE.
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2112
Practice Address - Country:US
Practice Address - Phone:510-524-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS4277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18359ZMedicare PIN