MEDICARE: MS. KATHLEEN ROMAN GREEN LCSW

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	CW013826	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7202328	OTHER	AETNA
2	072377	OTHER	MAGELLAN
3	211357	OTHER	VALUE OPTIONS
4	334772	OTHER	MENTAL HEALTH NETWORK

General Provider Information

NPI Number	:	1154383271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ROMAN GREEN LCSW

Provider Business Mailing Address
First Line	:	105 PURITAN RD
Second Line	:
City	:	CARNEGIE
State	:	PA
Zip	:	15106-1025
Country	:	US
Telephone Number	:	412-276-7139
Fax Number	:	412-276-3101

Provider Business Practice Location Address
First Line	:	485 MANSFIELD AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-4350
Country	:	US
Telephone Number	:	412-922-1566
Fax Number	:	412-922-3516

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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