Provider Demographics
NPI:1821167776
Name:GREEN, KIMBERLEE MARGESON (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:MARGESON
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 1:15 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1032
Mailing Address - Country:US
Mailing Address - Phone:413-567-3459
Mailing Address - Fax:
Practice Address - Street 1:1200 CONVERSE ST
Practice Address - Street 2:201
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1760
Practice Address - Country:US
Practice Address - Phone:413-567-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1280OtherBCBSMA
MA38022OtherHEALTH NEW ENGLAND