Provider Demographics
NPI:1386990836
Name:GREENE, JARED (BS)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1557
Mailing Address - Country:US
Mailing Address - Phone:561-366-9400
Mailing Address - Fax:561-366-4845
Practice Address - Street 1:3111 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1557
Practice Address - Country:US
Practice Address - Phone:561-366-9400
Practice Address - Fax:561-366-4845
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL759123300Medicaid