| Doctor Name: | MR. KENNETH RYAN GREENE |
| NPI Number: | 1336169515 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSWR |
| License Number: | R049290-1 |
| Business Practice Address: | 28 N Main St Suite C Bainbridge, NY - 137331233 |
| Business Phone Number: | 6072444668 |
| Business Fax Number: | |
| Mailing Address: | 28 N Main St, Suite C BAINBRIDGE |
| State: | NY |
| Postal Code: | 137331233 |
| Phone Number: | 6072444668 |
| Fax Number: | |
| NPI Enumeration Date: | 07/20/2006 |
| NPI Last Update Date: | 01/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R049290-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |