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General NPI Number Information
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NPI Number | 1972893832
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Entity Type | Individual
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Provider Name | CAROLYN JOAN GREEN M.S.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 1639 FORUM PL SUITE 7
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2330
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Country | US
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Telephone | 561-255-6181
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Fax | 561-795-7192
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Provider Business Mailing Address
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Address Line | 8508 WATER CAY
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-5556
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Country | US
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Telephone | 561-255-6181
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Fax | 561-795-7192
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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 | IMH 7309
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License Number State | FL
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