MEDICARE: MRS. VICTORIA GREEN LMHC

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	101YM0800X	Mental Health Counselor	008573	NY

General Provider Information

NPI Number	:	1639563018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA GREEN LMHC

Provider Business Mailing Address
First Line	:	60 FIRE ISLAND AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3502
Country	:	US
Telephone Number	:	631-716-5425
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 FIRE ISLAND AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3502
Country	:	US
Telephone Number	:	631-716-5424
Fax Number	:

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

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	01/30/2025

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