Provider Demographics
NPI:1235602095
Name:GREEN, PAULINE (LICENSE MASTER SW)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LICENSE MASTER SW
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAULINE GREEN LMSW
Mailing Address - Street 1:185 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4014
Mailing Address - Country:US
Mailing Address - Phone:917-640-1393
Mailing Address - Fax:
Practice Address - Street 1:185 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4014
Practice Address - Country:US
Practice Address - Phone:917-640-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101658104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty