Provider Demographics
NPI:1831469295
Name:GREEN, NOELLE MARIE (M ED, BCABA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:M ED, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 KERRY LYNN CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3148
Mailing Address - Country:US
Mailing Address - Phone:856-629-4346
Mailing Address - Fax:
Practice Address - Street 1:66 KERRY LYNN CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-3148
Practice Address - Country:US
Practice Address - Phone:856-629-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-02-0579103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst