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NPI Code Detail

MEDICARE: MS. AMY LARSSON GREENE MA

MEDICARE:  MS. AMY LARSSON GREENE  MA
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
11041C0700XClinical Social Worker1025610MA

General Provider Information

NPI Number : 1720141369
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY LARSSON GREENE MA
Provider Business Mailing Address
First Line : 95 ERIE AVE
Second Line :
City : NEWTON
State : MA
Zip : 02461-1515
Country : US
Telephone Number : 617-964-5326
Fax Number : 617-964-5326
Provider Business Practice Location Address
First Line : 24 LINCOLN ST
Second Line :
City : NEWTON
State : MA
Zip : 02461-1524
Country : US
Telephone Number : 617-964-5326
Fax Number : 617-964-5326
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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Directions to “ MS. AMY LARSSON GREENE MA” Practice Location

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