=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275760134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN MARY GREENEN M.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2009
-----------------------------------------------------
Last Update Date | 05/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 PUTNEY RD # 301
-----------------------------------------------------
City | BRATTLEBORO
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05301-9000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-451-6055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 92 POPLAR CMNS
-----------------------------------------------------
City | DUMMERSTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05301-9423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-451-6055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 100.011498
-----------------------------------------------------
License Number State |
-----------------------------------------------------