Provider Demographics
NPI:1942099148
Name:GREENE, BROOKLYN
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 BURSTOCK RD APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-3350
Mailing Address - Country:US
Mailing Address - Phone:614-270-4859
Mailing Address - Fax:614-270-4859
Practice Address - Street 1:1460 BURSTOCK RD APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-3350
Practice Address - Country:US
Practice Address - Phone:614-270-4859
Practice Address - Fax:614-270-4859
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator