Basic Information
| Provider Information | |||||||||
| NPI: | 1376069245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 WOODMAN DR | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454321446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372530606 | ||||||||
| FaxNumber: | 9372530707 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 WOODMAN DR | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454321446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372530606 | ||||||||
| FaxNumber: | 9372530707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2017 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 1041C0700X | I.2002242 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.