Healthcare Provider Details

I. General information

NPI: 1679405658
Provider Name (Legal Business Name): FIONA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HUNTINGTON AVE
BOSTON MA
02115-5000
US

IV. Provider business mailing address

36 HAWTHORNE ST APT 1
BOSTON MA
02119-1411
US

V. Phone/Fax

Practice location:
  • Phone: 617-373-3195
  • Fax:
Mailing address:
  • Phone: 650-283-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: