Provider Demographics
NPI:1831756451
Name:GREEN, TAYLOR A
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:GREEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 MONTALTO XING UNIT H
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7535
Mailing Address - Country:US
Mailing Address - Phone:240-344-9570
Mailing Address - Fax:
Practice Address - Street 1:10514 RACETRACK RD STE G
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3241
Practice Address - Country:US
Practice Address - Phone:410-973-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD483106300Medicaid