Provider Demographics
NPI:1861014409
Name:GREEN, JAMES BOLTEN (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BOLTEN
Last Name:GREEN
Suffix:
Gender:M
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LINDEN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1738
Mailing Address - Country:US
Mailing Address - Phone:508-397-0853
Mailing Address - Fax:
Practice Address - Street 1:75 FENWOOD RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6103
Practice Address - Country:US
Practice Address - Phone:617-754-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor