Provider Demographics
NPI:1023909223
Name:GREENE, FALLON ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:FALLON
Middle Name:ELAINE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-0072
Mailing Address - Country:US
Mailing Address - Phone:909-754-8864
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 72
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325-0072
Practice Address - Country:US
Practice Address - Phone:909-754-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health