MEDICARE: MS. ALLISON VICTORIA GREEN MSW

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		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	135968121	OTHER	WI	STATE

General Provider Information

NPI Number	:	1124982970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLISON VICTORIA GREEN MSW

Provider Business Mailing Address
First Line	:	1172 SIMPSON ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-1279
Country	:	US
Telephone Number	:	850-860-2181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1172 SIMPSON ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32526-1279
Country	:	US
Telephone Number	:	850-860-2181
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	01/10/2026

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