Basic Information
| Provider Information | |||||||||
| NPI: | 1083962724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 CLAY CT | ||||||||
| Address2: | |||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125722500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163950806 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5 CLAY CT | ||||||||
| Address2: | |||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125722500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163950806 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2012 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 001379 | NY | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.