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General NPI Number Information
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NPI Number | 1255397626
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Entity Type | Individual
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Provider Name | CARROLL H GREENE III PHD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 6017 CASSOWARY LN
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City | NEW BERN
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State | NC
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Zip | 28560-7170
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Country | US
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Telephone | 252-288-4681
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Fax |
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Provider Business Mailing Address
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Address Line | 6017 CASSOWARY LN
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City | NEW BERN
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State | NC
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Zip | 28560-7170
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Country | US
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Telephone | 252-288-4681
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001484
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 5282
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License Number State | FL
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