Provider Demographics
NPI:1003388513
Name:GREEN, CASEY MARIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4099
Mailing Address - Country:US
Mailing Address - Phone:410-612-1546
Mailing Address - Fax:
Practice Address - Street 1:407 TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-4099
Practice Address - Country:US
Practice Address - Phone:410-612-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148231041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool