Provider Demographics
NPI:1922113992
Name:GREEN, JONAH DAVID (MSW)
Entity Type:Individual
Prefix:MR
First Name:JONAH
Middle Name:DAVID
Last Name:GREEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 KNOWLES AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895
Mailing Address - Country:US
Mailing Address - Phone:301-466-9526
Mailing Address - Fax:301-949-0677
Practice Address - Street 1:3930 KNOWLES AVE STE 200
Practice Address - Street 2:SUITE 200
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2428
Practice Address - Country:US
Practice Address - Phone:301-967-7567
Practice Address - Fax:301-949-0677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD094491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD026303601Medicaid
MD491763Medicare ID - Type Unspecified
569849Medicare UPIN