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General NPI Number Information
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NPI Number | 1518641471
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Entity Type | Individual
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Provider Name | JESSICA SHANTE GREEN LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 1208 E CHURCHVILLE RD STE 300
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City | BEL AIR
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State | MD
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Zip | 21014-3485
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Country | US
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Telephone | 410-893-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 950 S GEORGE MASON DR APT 714
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City | ARLINGTON
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State | VA
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Zip | 22204-1864
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Country | US
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Telephone | 706-329-7050
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Fax |
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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 | MSW010482
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0903003712
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 30282
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License Number State | MD
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