Healthcare Provider Details

I. General information

NPI: 1417630450
Provider Name (Legal Business Name): HUNTER GREEN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ACADEMY ST
LACONIA NH
03246-3606
US

IV. Provider business mailing address

35 ACADEMY ST
LACONIA NH
03246-3606
US

V. Phone/Fax

Practice location:
  • Phone: 603-556-4360
  • Fax:
Mailing address:
  • Phone: 603-556-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136529
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW20765
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1019
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: