Healthcare Provider Details

I. General information

NPI: 1265356521
Provider Name (Legal Business Name): JENNIFER A. GREENE, LICENSED CLINICAL SOCIAL WORKER, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 W CONE BLVD STE 209
GREENSBORO NC
27408-4027
US

IV. Provider business mailing address

11 FLAGSHIP CV
GREENSBORO NC
27455-3428
US

V. Phone/Fax

Practice location:
  • Phone: 845-654-3443
  • Fax:
Mailing address:
  • Phone: 845-654-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANNE GREENE
Title or Position: OWNER
Credential: LCSW
Phone: 845-206-6941