Healthcare Provider Details

I. General information

NPI: 1407625965
Provider Name (Legal Business Name): KATRINA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8767 PHILADELPHIA RD STE A PMB 1020
ROSEDALE MD
21237-4901
US

IV. Provider business mailing address

8767 PHILADELPHIA RD STE A PMB 1020
ROSEDALE MD
21237-4901
US

V. Phone/Fax

Practice location:
  • Phone: 443-517-2466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28483
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: