MEDICARE: DR. JONATHAN GREENE PSYD, LMFT, CATC

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	106H00000X	Marriage & Family Therapist	MFC46155	CA

General Provider Information

NPI Number	:	1841430451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN GREENE PSYD, LMFT, CATC

Provider Business Mailing Address
First Line	:	1375 E ROSARITO WAY
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-3357
Country	:	US
Telephone Number	:	760-250-4008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 E ROSARITO WAY
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-3357
Country	:	US
Telephone Number	:	760-250-4008
Fax Number	:

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

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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