Provider Demographics
NPI:1124917653
Name:GREEN, MEGGEN (LLMSW)
Entity type:Individual
Prefix:
First Name:MEGGEN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60455 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MI
Mailing Address - Zip Code:48048-1753
Mailing Address - Country:US
Mailing Address - Phone:586-604-3003
Mailing Address - Fax:
Practice Address - Street 1:30472 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1844
Practice Address - Country:US
Practice Address - Phone:586-863-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511193891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical