Provider Demographics
NPI:1114183506
Name:GREEN, MAXINE K (RNC)
Entity Type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:K
Last Name:GREEN
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 K ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4216
Mailing Address - Country:US
Mailing Address - Phone:202-442-4142
Mailing Address - Fax:202-371-1657
Practice Address - Street 1:35 K ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4216
Practice Address - Country:US
Practice Address - Phone:202-442-4142
Practice Address - Fax:202-371-1657
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN35610101YM0800X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health