Basic Information
| Provider Information | |||||||||
| NPI: | 1003017674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 OXFORD CT | ||||||||
| Address2: | |||||||||
| City: | WHEATLEY HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117981123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315863598 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5 OXFORD CT | ||||||||
| Address2: | |||||||||
| City: | WHEATLEY HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117981123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315863598 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 011587-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.