Healthcare Provider Details

I. General information

NPI: 1487998563
Provider Name (Legal Business Name): LINDA CONN GREEN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SE FEDERAL HWY
STUART FL
34994-3823
US

IV. Provider business mailing address

1430 SW COVERED BRIDGE RD
PALM CITY FL
34990-1909
US

V. Phone/Fax

Practice location:
  • Phone: 772-320-0770
  • Fax: 772-320-0180
Mailing address:
  • Phone: 772-708-7381
  • Fax: 772-320-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: