=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811171994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAAYAN GREENE M.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2007
-----------------------------------------------------
Last Update Date | 07/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5625 COLLEGE AVE SUITE 215
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94618-1599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-463-4506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 WELDON AVE APT 206
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94610-1540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-572-3501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 24515
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------