MEDICARE: PATRICIA DWYER GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102029	MA

General Provider Information

NPI Number	:	1114403847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA DWYER GREEN

Provider Business Mailing Address
First Line	:	104 CANTON AVE
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-3507
Country	:	US
Telephone Number	:	617-696-8341
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 CANTON AVE
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-3507
Country	:	US
Telephone Number	:	617-696-8341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	07/16/2018

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Directions to “ PATRICIA DWYER GREEN ” Practice Location

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