Provider Demographics
NPI:1487072922
Name:GREENLEE, ALECIA (MD)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E HAMILTON AVE # 1020
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0210
Mailing Address - Country:US
Mailing Address - Phone:408-800-3149
Mailing Address - Fax:408-413-0463
Practice Address - Street 1:3569 ROUND BARN CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-5781
Practice Address - Country:US
Practice Address - Phone:408-800-3149
Practice Address - Fax:408-413-0463
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336.1071212084P0800X
MA2696032084P0800X
CAA1696802084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry