Healthcare Provider Details

I. General information

NPI: 1902573710
Provider Name (Legal Business Name): MISS AKALIA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 DEAN ST APT 1B
STAMFORD CT
06902-6245
US

IV. Provider business mailing address

3 DEAN ST APT 1B
STAMFORD CT
06902-6245
US

V. Phone/Fax

Practice location:
  • Phone: 203-832-5768
  • Fax:
Mailing address:
  • Phone: 203-832-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9234
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: