Provider Demographics
NPI:1932297561
Name:GREEN, ANITRA JEANETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITRA
Middle Name:JEANETTE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 PEYTON ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5297
Mailing Address - Country:US
Mailing Address - Phone:484-716-0336
Mailing Address - Fax:610-497-7588
Practice Address - Street 1:86 PEYTON ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5297
Practice Address - Country:US
Practice Address - Phone:484-840-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124588101YM0800X
PACW0176871041C0700X
DEQ1-00118971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health