Healthcare Provider Details

I. General information

NPI: 1205957313
Provider Name (Legal Business Name): LYNETTE M GREENE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
DANSVILLE NY
14437-1709
US

IV. Provider business mailing address

6870 CAMPBELL RD
GAINESVILLE NY
14066-9753
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax: 585-335-3577
Mailing address:
  • Phone: 716-560-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069500-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077017-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number78012
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: