Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3678-57 | WI |
Y | 103T00000X | Psychologist | 3678-57 | WI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3678-57 | WI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3678-57 | WI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3678-57 | WI |
N | 103TF0200X | Forensic Psychologist | 3678-57 | WI |
N | 103TM1800X | Intellectual & Developmental Disabilities | 3678-57 | WI |
N | 103TP2701X | Group Psychotherapist | 3678-57 | WI |
NPI | 1396309076 |
---|---|
Provider Name | Dr. John Nathaniel Greene JR. |
First Address | Bayside, WI 53217-1321 |
Second Address | Milwaukee, WI 53209-3560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2019 |
Last Update Date | 09/05/2019 |