Provider Demographics
NPI:1326299223
Name:GREEN, ALEXANDER M (BA)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:M
Last Name:GREEN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MR
Other - First Name:ALEXANDER
Other - Middle Name:M
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:12 TRULL ST
Mailing Address - Street 2:#1
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2126
Mailing Address - Country:US
Mailing Address - Phone:240-353-3906
Mailing Address - Fax:
Practice Address - Street 1:12 TRULL ST
Practice Address - Street 2:#1
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-2126
Practice Address - Country:US
Practice Address - Phone:240-353-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health