Provider Demographics
NPI:1922173228
Name:GREEN, JEWEL (LCSW, LICSW, LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:JEWEL
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 31ST ST S
Mailing Address - Street 2:STE. 508
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-4916
Mailing Address - Country:US
Mailing Address - Phone:202-270-6519
Mailing Address - Fax:
Practice Address - Street 1:5247 WISCONSIN AVE NW
Practice Address - Street 2:NO. 3, 2ND FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2012
Practice Address - Country:US
Practice Address - Phone:202-270-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500778481041C0700X
MD121261041C0700X
VA09040056711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical