Provider Demographics
NPI:1295024123
Name:GREEN, ELIZABETH M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MAPLE ST
Mailing Address - Street 2:BOX 404
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216-3910
Mailing Address - Country:US
Mailing Address - Phone:603-818-6781
Mailing Address - Fax:603-735-5860
Practice Address - Street 1:140 MAPLE ST
Practice Address - Street 2:BOX 404
Practice Address - City:ANDOVER
Practice Address - State:NH
Practice Address - Zip Code:03216-3910
Practice Address - Country:US
Practice Address - Phone:603-818-6781
Practice Address - Fax:603-735-5860
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHLCMHC 31101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health