MEDICARE: EDWARD A 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	01647	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80552W	OTHER	TX	BCBS TEXAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639171515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD A GREEN LCSW

Provider Business Mailing Address
First Line	:	4018 MEADOWGOLD LN
Second Line	:	SUITE 125
City	:	KINGWOOD
State	:	TX
Zip	:	77345-1008
Country	:	US
Telephone Number	:	832-622-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 N SAM HOUSTON PKWY E
Second Line	:	SUITE 125
City	:	HOUSTON
State	:	TX
Zip	:	77060-4021
Country	:	US
Telephone Number	:	832-622-2386
Fax Number	:	800-434-4305

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/07/2016

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Directions to “ EDWARD A GREEN LCSW” Practice Location

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