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General NPI Number Information
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NPI Number | 1679804504
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Entity Type | Individual
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Provider Name | MARTINA R GREEN MHC
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Gender | Female
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 325 N MAIN ST
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City | NATICK
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State | MA
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Zip | 01760-1129
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Country | US
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Telephone | 508-358-2657
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Fax | 508-524-2276
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Provider Business Mailing Address
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Address Line | 10 CONCORD RD
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City | WAYLAND
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State | MA
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Zip | 01778-1902
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Country | US
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Telephone | 508-358-2657
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Fax | 508-524-2276
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 930
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License Number State | MA
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