Provider Demographics
NPI:1942420740
Name:GREEN, CECEILE MCINTOSH (MS, PHD CANDIDATE)
Entity Type:Individual
Prefix:MS
First Name:CECEILE
Middle Name:MCINTOSH
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, PHD CANDIDATE
Other - Prefix:
Other - First Name:CECEILE
Other - Middle Name:M
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10417 131ST ST
Mailing Address - Street 2:SOUTH RICHMOND HILL
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-3107
Mailing Address - Country:US
Mailing Address - Phone:718-322-4831
Mailing Address - Fax:718-322-4831
Practice Address - Street 1:9001 MERRICK BLVD
Practice Address - Street 2:JAMAICA
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5244
Practice Address - Country:US
Practice Address - Phone:718-523-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health