Provider Demographics
NPI:1629143839
Name:GREEN, MATTHEW (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1507
Mailing Address - Country:US
Mailing Address - Phone:617-964-1060
Mailing Address - Fax:
Practice Address - Street 1:34 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1507
Practice Address - Country:US
Practice Address - Phone:617-964-1060
Practice Address - Fax:617-630-0381
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA012651OtherVALUE OPTIONS
MA773192OtherTUFTS
MA1892398Medicaid
MALM0129OtherBLUE CROSS BLUE SHIELD