Healthcare Provider Details

I. General information

NPI: 1922371566
Provider Name (Legal Business Name): KRISTA ANN GREENE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA ANN MALICK CSW

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 WALNUT BOTTOM ROAD
CARLISLE PA
17015-6926
US

IV. Provider business mailing address

1229 SCENERY DRIVE
MECHANICSBURG PA
17055-1942
US

V. Phone/Fax

Practice location:
  • Phone: 717-249-0085
  • Fax: 717-249-0647
Mailing address:
  • Phone: 717-796-6550
  • Fax: 717-796-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW126917
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: