MEDICARE: YANIQUE PATRICE 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1518350313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANIQUE PATRICE GREEN

Provider Business Mailing Address
First Line	:	523 LONDON RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 LONDON RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-2511
Country	:	US
Telephone Number	:	914-356-4573
Fax Number	:

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

Provider Enumeration Date	:	03/18/2015
Last Update Date	:	03/18/2015

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Directions to “ YANIQUE PATRICE GREEN ” Practice Location

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