Provider Demographics
NPI:1255191284
Name:GREEN, COURTNEY L (LCSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
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 1:24 DUNHAM RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1843
Mailing Address - Country:US
Mailing Address - Phone:978-578-8151
Mailing Address - Fax:
Practice Address - Street 1:24 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1843
Practice Address - Country:US
Practice Address - Phone:978-578-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical