Provider Demographics
NPI:1457523037
Name:GREEN, CHERYL M (MA,LMHC; LMFT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA,LMHC; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BROOKFIELD RD
Mailing Address - Street 2:P.O. BOX 255
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-9794
Mailing Address - Country:US
Mailing Address - Phone:413-245-9244
Mailing Address - Fax:
Practice Address - Street 1:22 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-9794
Practice Address - Country:US
Practice Address - Phone:413-245-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist