Provider Demographics
NPI:1780098244
Name:GREEN, JEFFREY (MPC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:MPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WALDEN ST
Mailing Address - Street 2:APT. 4T
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-3507
Mailing Address - Country:US
Mailing Address - Phone:617-939-6454
Mailing Address - Fax:
Practice Address - Street 1:555 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3906
Practice Address - Country:US
Practice Address - Phone:978-454-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)