Healthcare Provider Details

I. General information

NPI: 1427247261
Provider Name (Legal Business Name): TERESA GREEN LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 NEW JERSEY AVE NW
WASHINGTON DC
20001-1365
US

IV. Provider business mailing address

1125 NEW JERSEY AVE NW
WASHINGTON DC
20001-1365
US

V. Phone/Fax

Practice location:
  • Phone: 240-342-0918
  • Fax:
Mailing address:
  • Phone: 240-233-4645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11568
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC303558
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: