MEDICARE: KRISTEN SCARLETT GREENE MSW, LCSWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1043794910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN SCARLETT GREENE MSW, LCSWA

Provider Business Mailing Address
First Line	:	7401 DELTA LAKE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-2838
Country	:	US
Telephone Number	:	828-748-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	16600 BIRKDALE COMMONS PKWY STE D
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-6181
Country	:	US
Telephone Number	:	704-564-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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