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NPI Code Detail

MEDICARE: CAROLYN GREENE LSW,LICDCLLL

MEDICARE: CAROLYN GREENE LSW,LICDCLLL
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
1101Y00000XCounselorS1201244OH
2101Y00000XCounselor121156OH

General Provider Information

NPI Number : 1861842551
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN GREENE LSW,LICDCLLL
Provider Business Mailing Address
First Line : 8411 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44105-3932
Country : US
Telephone Number : 216-206-5201
Fax Number : 216-441-3637
Provider Business Practice Location Address
First Line : 8411 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44105-3932
Country : US
Telephone Number : 216-206-5201
Fax Number : 216-441-3637
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2016
Last Update Date : 06/14/2016

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Directions to “ CAROLYN GREENE LSW,LICDCLLL” Practice Location

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