Provider Demographics
NPI:1952495657
Name:GREEN, NANCY ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANNE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:ANNE
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW; LICSW
Mailing Address - Street 1:3550 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1196
Mailing Address - Country:US
Mailing Address - Phone:503-331-6456
Mailing Address - Fax:503-249-5508
Practice Address - Street 1:3550 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1196
Practice Address - Country:US
Practice Address - Phone:503-331-6456
Practice Address - Fax:503-249-5508
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health