Healthcare Provider Details

I. General information

NPI: 1750106746
Provider Name (Legal Business Name): GREEN ROOM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 W MAIN ST
MARLBOROUGH MA
01752-5510
US

IV. Provider business mailing address

11 APEX DR SUITE 300A #110
MARLBOROUGH MA
01752
US

V. Phone/Fax

Practice location:
  • Phone: 401-323-5126
  • Fax:
Mailing address:
  • Phone: 401-323-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. GABRIELLE ARIANA SCHEFF
Title or Position: SOC SIGNATORY
Credential: LMHC
Phone: 401-323-5126