Healthcare Provider Details

I. General information

NPI: 1194213090
Provider Name (Legal Business Name): MAKEDA GREENE PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 GEORGIA AVE STE 450
SILVER SPRING MD
20910-4962
US

IV. Provider business mailing address

14800 4TH ST APT 73B
LAUREL MD
20707-3714
US

V. Phone/Fax

Practice location:
  • Phone: 917-982-9494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: