Healthcare Provider Details

I. General information

NPI: 1326669656
Provider Name (Legal Business Name): S KIMBLE GREENE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W POWNAL RD
NORTH YARMOUTH ME
04097-6818
US

IV. Provider business mailing address

50 W POWNAL RD
NORTH YARMOUTH ME
04097-6818
US

V. Phone/Fax

Practice location:
  • Phone: 860-316-7530
  • Fax:
Mailing address:
  • Phone: 860-316-7530
  • 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: