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General NPI Number Information
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NPI Number | 1881762607
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Entity Type | Individual
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Provider Name | CAROL E GREEN LIC. AC.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | DEDHAM HEALTH ATHLETIC COMPLEX 200 PROVIDENCE HIGHWAY
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City | DEDHAM
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State | MA
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Zip | 02026
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Country | US
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Telephone | 781-467-1245
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Fax |
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Provider Business Mailing Address
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Address Line | 123 SOUTH ST
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-3163
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Country | US
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Telephone | 781-467-1245
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 209484
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License Number State | MA
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