Healthcare Provider Details

I. General information

NPI: 1639590789
Provider Name (Legal Business Name): CLAIRE GREENE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 GRIEGOS RD NW
ALBUQUERQUE NM
87107-3752
US

IV. Provider business mailing address

1218 GRIEGOS RD NW
ALBUQUERQUE NM
87107-3752
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-5935
  • Fax:
Mailing address:
  • Phone: 505-342-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-08367
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: