MEDICARE: KERNESHA L GREENE C.D.C.A

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		OH
2	171M00000X	Case Manager/Care Coordinator		OH
3	251S00000X	Community/Behavioral Health Agency	100283	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467971911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERNESHA L GREENE C.D.C.A

Provider Business Mailing Address
First Line	:	4834 RICHMOND RD STE 150
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-6408
Country	:	US
Telephone Number	:	216-561-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4834 RICHMOND RD STE 150
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-6408
Country	:	US
Telephone Number	:	216-561-8300
Fax Number	:

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

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	04/20/2026

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