Provider Demographics
NPI:1760368633
Name:GREENE, BRANDON (MA/PPSC)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:MA/PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MILITARY W
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2428
Mailing Address - Country:US
Mailing Address - Phone:707-747-8334
Mailing Address - Fax:
Practice Address - Street 1:1101 MILITARY W
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2428
Practice Address - Country:US
Practice Address - Phone:707-747-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230242980101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool