Provider Demographics
NPI:1487482766
Name:GREENE, MYKEL (MS)
Entity type:Individual
Prefix:
First Name:MYKEL
Middle Name:
Last Name:GREENE
Suffix:
Gender:X
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W CHESTER PIKE APT F27
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5085
Mailing Address - Country:US
Mailing Address - Phone:484-703-9290
Mailing Address - Fax:
Practice Address - Street 1:1100 W CHESTER PIKE APT F27
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5085
Practice Address - Country:US
Practice Address - Phone:215-839-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty