Healthcare Provider Details

I. General information

NPI: 1669371092
Provider Name (Legal Business Name): EMILY GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 MAYBEE RD
CLARKSTON MI
48346-3264
US

IV. Provider business mailing address

5520 CRABTREE RD
BLOOMFIELD HILLS MI
48301-1200
US

V. Phone/Fax

Practice location:
  • Phone: 248-623-4141
  • Fax: 248-623-4105
Mailing address:
  • Phone: 517-525-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: