MEDICARE: MONICA LYNNE GREENE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	03445	MD

General Provider Information

NPI Number	:	1023307444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA LYNNE GREENE PHD

Provider Business Mailing Address
First Line	:	1300 MERCANTILE LN
Second Line	:	STE 139 C
City	:	LARGO
State	:	MD
Zip	:	20774-5327
Country	:	US
Telephone Number	:	301-322-2118
Fax Number	:	301-322-2377

Provider Business Practice Location Address
First Line	:	7905 BELLE POINT DR
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-3329
Country	:	US
Telephone Number	:	240-304-0307
Fax Number	:	301-322-2377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	07/01/2021

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