Provider Demographics
NPI:1255166146
Name:EVANS-GREEN, CONNOR DENNIS (LCSW)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:DENNIS
Last Name:EVANS-GREEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 JARVES ST UNIT 9A
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2286
Mailing Address - Country:US
Mailing Address - Phone:508-246-6561
Mailing Address - Fax:
Practice Address - Street 1:365 QUAKER MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1373
Practice Address - Country:US
Practice Address - Phone:508-888-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2216931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical