Provider Demographics
NPI:1437599131
Name:LINDA C GREEN LCSW INC
Entity Type:Organization
Organization Name:LINDA C GREEN LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CONN
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-708-7381
Mailing Address - Street 1:1257 SW MARTIN HWY UNIT 56
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34991-5004
Mailing Address - Country:US
Mailing Address - Phone:772-708-7381
Mailing Address - Fax:
Practice Address - Street 1:1257 SW MARTIN HWY UNIT 56
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34991-5004
Practice Address - Country:US
Practice Address - Phone:772-708-7381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW10749251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health