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General NPI Number Information
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NPI Number | 1063985547
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Entity Type | Individual
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Provider Name | LEON G GREEN LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 51 COVENTRY ST
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City | HARTFORD
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State | CT
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Zip | 06112-1525
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Country | US
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Telephone | 860-293-6355
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Fax | 860-297-0915
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Provider Business Mailing Address
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Address Line | 2550 ALBANY AVE # 1174
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2335
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Country | US
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Telephone | 860-752-3432
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Fax | 860-297-0915
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4645
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 58.011331
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11331
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License Number State | CT
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