Provider Demographics
NPI:1073973848
Name:GREEN, DANNY E JR (BA)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:E
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-4523
Mailing Address - Country:US
Mailing Address - Phone:321-800-4488
Mailing Address - Fax:321-800-4499
Practice Address - Street 1:1221 W COLONIAL DR STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7164
Practice Address - Country:US
Practice Address - Phone:321-800-4488
Practice Address - Fax:321-800-4488
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker