Provider Demographics
NPI:1205466471
Name:GREEN, KAJSIA M (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:KAJSIA
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:KAJSIA
Other - Middle Name:M
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:82 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2388
Mailing Address - Country:US
Mailing Address - Phone:845-486-2783
Mailing Address - Fax:
Practice Address - Street 1:82 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2388
Practice Address - Country:US
Practice Address - Phone:845-486-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty