Provider Demographics
NPI:1780726059
Name:GREEN, SHARI P (RNCS, MA CAGS)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:P
Last Name:GREEN
Suffix:
Gender:F
Credentials:RNCS, MA CAGS
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:
Other - Last Name:PIZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-853-7149
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2038
Practice Address - Country:US
Practice Address - Phone:508-856-0732
Practice Address - Fax:508-853-7149
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARNCS229207364SP0809X
RIPPNS00104364S00000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA999OtherLMHC
RIPPNS00104OtherCNS
MA229207OtherRN LICENSE
RIRN50561OtherNURSING LICENSE