Provider Demographics
NPI:1700938404
Name:GREEN, NANCY E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CROWNINSHIELD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6762
Mailing Address - Country:US
Mailing Address - Phone:617-566-0164
Mailing Address - Fax:617-566-5658
Practice Address - Street 1:173 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5521
Practice Address - Country:US
Practice Address - Phone:617-738-5305
Practice Address - Fax:781-237-9930
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA101716OtherPROFESSIONAL LICENSE #