Healthcare Provider Details

I. General information

NPI: 1518976422
Provider Name (Legal Business Name): MARJORIE GREEN JOSEPH LICSW, LADC1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

IV. Provider business mailing address

15 CHERRYSTONE RD
FAIRHAVEN MA
02719-7034
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-3504
  • Fax:
Mailing address:
  • Phone: 508-994-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105823
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierFAL2225000710
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLU CROSS BLUE SHIELD
# 2
Identifier1306685
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: