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General NPI Number Information
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NPI Number | 1639171515
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Entity Type | Individual
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Provider Name | EDWARD A GREEN LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 507 N SAM HOUSTON PKWY E SUITE 125
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City | HOUSTON
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State | TX
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Zip | 77060-4021
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Country | US
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Telephone | 832-622-2386
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Fax | 800-434-4305
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Provider Business Mailing Address
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Address Line | 4018 MEADOWGOLD LN SUITE 125
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City | KINGWOOD
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State | TX
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Zip | 77345-1008
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Country | US
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Telephone | 832-622-2386
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 01647
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License Number State | TX
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