Healthcare Provider Details

I. General information

NPI: 1912591017
Provider Name (Legal Business Name): CAROLINE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 SAN MATEO BLVD NE APT 1072
ALBUQUERQUE NM
87113-2609
US

IV. Provider business mailing address

267 MAIN ST APT 3
EAST GREENWICH RI
02818-3759
US

V. Phone/Fax

Practice location:
  • Phone: 617-840-5239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC5000971
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01497
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: