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NPI Code Detail

MEDICARE: MR. CHRISTOPHER J GREEN MSW, LICSW

MEDICARE: MR. CHRISTOPHER J GREEN MSW, LICSW
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 Worker18356MN

General Provider Information

NPI Number : 1942438239
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER J GREEN MSW, LICSW
Provider Business Mailing Address
First Line : 603 BRUCE ST
Second Line :
City : CROOKSTON
State : MN
Zip : 56716-2914
Country : US
Telephone Number : 218-289-6081
Fax Number : 218-281-6261
Provider Business Practice Location Address
First Line : 603 BRUCE ST
Second Line :
City : CROOKSTON
State : MN
Zip : 56716-2914
Country : US
Telephone Number : 218-289-6081
Fax Number : 218-281-6261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2009
Last Update Date : 06/25/2009

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