Provider Demographics
NPI:1982328035
Name:GREENE, RAFFAELLA (LAC)
Entity type:Individual
Prefix:
First Name:RAFFAELLA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2426
Mailing Address - Country:US
Mailing Address - Phone:732-200-2886
Mailing Address - Fax:
Practice Address - Street 1:9 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2426
Practice Address - Country:US
Practice Address - Phone:732-200-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00661300101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor