Provider Demographics
NPI:1699577676
Name:KWAME-GREENE, GLENNA
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:KWAME-GREENE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11402 COVERED BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9130
Mailing Address - Country:US
Mailing Address - Phone:301-814-0037
Mailing Address - Fax:877-408-0066
Practice Address - Street 1:11402 COVERED BRIDGE CT
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9130
Practice Address - Country:US
Practice Address - Phone:301-814-0037
Practice Address - Fax:301-814-0037
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TA0700X
103TB0200X, 103TH0100X, 103TM1800X, 103TP0016X, 103TR0400X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation