MEDICARE: MRS. CARA T GREENE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	RO38637-1	NY

General Provider Information

NPI Number	:	1063741239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARA T GREENE LCSW

Provider Business Mailing Address
First Line	:	259 HARBOR VIEW DR
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-4706
Country	:	US
Telephone Number	:	516-944-6789
Fax Number	:	516-944-8787

Provider Business Practice Location Address
First Line	:	259 HARBOR VIEW DR
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-4706
Country	:	US
Telephone Number	:	516-944-6789
Fax Number	:	516-944-8787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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