MEDICARE: RODNEY ROY GREEN LCSW, LMFT

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	LCS4680	CA
2	106H00000X	Marriage & Family Therapist	MFT7032	CA

General Provider Information

NPI Number	:	1194815605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY ROY GREEN LCSW, LMFT

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-0400
Country	:	US
Telephone Number	:	530-527-5631
Fax Number	:	530-527-0240

Provider Business Practice Location Address
First Line	:	1860 WALNUT ST
Second Line	:	SUITE A
City	:	RED BLUFF
State	:	CA
Zip	:	96080-3611
Country	:	US
Telephone Number	:	530-527-5631
Fax Number	:	530-527-0240

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/11/2025

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