MEDICARE: JULIE ANNE 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	104100000X	Social Worker	44SL06168800	NJ
2	1041C0700X	Clinical Social Worker	44SC06438900	NJ

General Provider Information

NPI Number	:	1811382658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANNE GREEN LCSW

Provider Business Mailing Address
First Line	:	858 WESTSIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6514
Country	:	US
Telephone Number	:	646-957-6157
Fax Number	:

Provider Business Practice Location Address
First Line	:	858 WESTSIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-6514
Country	:	US
Telephone Number	:	646-957-6157
Fax Number	:

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	01/28/2025

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