Healthcare Provider Details

I. General information

NPI: 1639095706
Provider Name (Legal Business Name): CONNER GREENE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ERDMAN WAY
LEOMINSTER MA
01453-1804
US

IV. Provider business mailing address

169 JOHNSON ST APT 206
LEOMINSTER MA
01453-4451
US

V. Phone/Fax

Practice location:
  • Phone: 978-696-3762
  • Fax:
Mailing address:
  • Phone: 978-696-3762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: