Healthcare Provider Details

I. General information

NPI: 1013433044
Provider Name (Legal Business Name): DANIEL GREENE LCSWR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LIBERTY ST STE 7
BATAVIA NY
14020-3246
US

IV. Provider business mailing address

741 DELAWARE AVE
BUFFALO NY
14209-2201
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-0614
  • Fax: 585-344-3868
Mailing address:
  • Phone: 716-218-1450
  • Fax: 716-332-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00039692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: