Provider Demographics
NPI:1437499100
Name:GOUDREAU-GREEN, NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:GOUDREAU-GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2220
Mailing Address - Country:US
Mailing Address - Phone:914-825-4800
Mailing Address - Fax:
Practice Address - Street 1:845 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:N WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603
Practice Address - Country:US
Practice Address - Phone:914-231-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0832581041C0700X
CT0078931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical