Basic Information
| Provider Information | |||||||||
| NPI: | 1982025755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | HILLEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8464 | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947078464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463192820 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SAN QUENTIN STATE PRISON | ||||||||
| Address2: | CENTRAL HEALTH SERVICES BUILDING 4TH FLOOR | ||||||||
| City: | SAN QUENTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154541460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2013 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 60108 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.