Provider Demographics
NPI:1760541957
Name:GREEN, JOAN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
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 STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461
Mailing Address - Country:US
Mailing Address - Phone:617-964-1060
Mailing Address - Fax:617-630-0381
Practice Address - Street 1:34 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461
Practice Address - Country:US
Practice Address - Phone:617-964-1060
Practice Address - Fax:617-630-0381
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA733101YM0800X
MA384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA019067OtherVALUE OPTIONS
MALM0069OtherBLUE CROSS BLUESHIELD
MA7323248OtherAETNA