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General NPI Number Information
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NPI Number | 1356697510
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Entity Type | Organization
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Legal Business Name | STEPHEN GREENE, PH.D. PC
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 49 OAK ST
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City | AUGUSTA
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State | ME
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Zip | 04330-5118
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Country | US
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Telephone | 207-649-4046
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Fax | 207-622-6290
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Provider Business Mailing Address
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Address Line | 138 PRIEST HILL RD
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City | VASSALBORO
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State | ME
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Zip | 04989-3305
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Country | US
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Telephone | 207-649-4046
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Fax | 207-622-6290
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | STEPHEN GREENE
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Credential | PH.D.
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Telephone | 207-649-4046
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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 | PS 1024
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License Number State | ME
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