Provider Demographics
NPI:1558926204
Name:GREEN, ABIGAIL HEDY
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:HEDY
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 N CLAY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3781
Mailing Address - Country:US
Mailing Address - Phone:480-466-3119
Mailing Address - Fax:
Practice Address - Street 1:12567 W CEDAR DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2009
Practice Address - Country:US
Practice Address - Phone:855-398-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health