Provider Demographics
NPI:1821850298
Name:THE GREEN THERAPEUTIC CENTER
Entity Type:Organization
Organization Name:THE GREEN THERAPEUTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:G
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-938-1208
Mailing Address - Street 1:2550 ALBANY AVE # 1174
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2335
Mailing Address - Country:US
Mailing Address - Phone:860-938-1208
Mailing Address - Fax:
Practice Address - Street 1:41 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2545
Practice Address - Country:US
Practice Address - Phone:860-780-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty