MEDICARE: DEVIN 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	130682	CA

General Provider Information

NPI Number	:	1578173290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN GREEN LCSW

Provider Business Mailing Address
First Line	:	12021 WILMINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	213-503-5167
Fax Number	:

Provider Business Practice Location Address
First Line	:	12021 WILMINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	213-503-5167
Fax Number	:

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

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	03/03/2026

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Directions to “ DEVIN GREEN LCSW” Practice Location

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