Provider Demographics
NPI:1114927845
Name:GREEN, BARBARA E (LISW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N LOCUST ST
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1192
Mailing Address - Country:US
Mailing Address - Phone:513-524-9727
Mailing Address - Fax:
Practice Address - Street 1:10 N LOCUST ST
Practice Address - Street 2:SUITE B-3
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1192
Practice Address - Country:US
Practice Address - Phone:513-524-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI05003891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
020309Medicare ID - Type Unspecified
S19055Medicare UPIN