Provider Demographics
NPI:1053193011
Name:GREENE, COURTNEY (MSW, LSW)
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 THORPE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1823
Mailing Address - Country:US
Mailing Address - Phone:937-559-6555
Mailing Address - Fax:
Practice Address - Street 1:25 THORPE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1823
Practice Address - Country:US
Practice Address - Phone:937-559-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2309158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker