Provider Demographics
NPI:1659438281
Name:GREEN, CAROL FRANCINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:FRANCINE
Last Name: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 1:59 307 PUPUKEA RD
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712
Mailing Address - Country:US
Mailing Address - Phone:808-638-9466
Mailing Address - Fax:
Practice Address - Street 1:56 565 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731
Practice Address - Country:US
Practice Address - Phone:808-293-9217
Practice Address - Fax:808-293-1171
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI30541041C0700X
OR3401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI548935Medicaid
HI548935Medicaid