Provider Demographics
NPI:1518333236
Name:GREEN, AMBER N (MSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:ELBERFELD
Mailing Address - State:IN
Mailing Address - Zip Code:47613-9237
Mailing Address - Country:US
Mailing Address - Phone:812-470-9172
Mailing Address - Fax:
Practice Address - Street 1:101 N PLAZA EAST BLVD STE 101
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2804
Practice Address - Country:US
Practice Address - Phone:812-508-8418
Practice Address - Fax:812-508-8478
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008539A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300091010Medicaid