Provider Demographics
NPI:1598547507
Name:GREEN, SARAH ELISABETH (BSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELISABETH
Last Name:GREEN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5814
Mailing Address - Country:US
Mailing Address - Phone:918-302-0052
Mailing Address - Fax:918-302-0082
Practice Address - Street 1:604 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5814
Practice Address - Country:US
Practice Address - Phone:918-302-0052
Practice Address - Fax:918-302-0082
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator