Active NPI
Glenn Gary Greene Sr., LMSW
- Clinical Social Worker
- Memphis, TN
National Provider Identifier
1306113592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LSW0000009089
- Practice address
- 5118 Park Ave
Memphis, TN 38117-5720 - Phone
- (901) 458-8638
- NPI assigned
- Nov 16, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LSW0000009089 | TN | Primary |
Addresses
Primary practice location
5118 Park Ave
Memphis, TN 38117-5720
Mailing address
5118 Park Ave
Memphis, TN 38117-5720
Phone (901) 458-8638
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LSW0000009089 | TN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impact Healthcare, PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Springfield, TN
- NPI 1639656986
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321401600000",
"number": "1306113592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5118 PARK AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381175720",
"telephone_number": "901-458-8638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5118 PARK AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381175720",
"telephone_number": "901-458-8638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENE",
"first_name": "GLENN",
"middle_name": "GARY",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-16",
"last_updated": "2011-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "LSW0000009089",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.