Provider Demographics
NPI:1699828764
Name:GREEN, JANET L (MSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 HIGH ST
Mailing Address - Street 2:STE B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4152
Mailing Address - Country:US
Mailing Address - Phone:541-343-4975
Mailing Address - Fax:541-431-7055
Practice Address - Street 1:1590 HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4152
Practice Address - Country:US
Practice Address - Phone:541-334-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR983OtherLICENSED CLINICAL SOCIAL