MEDICARE: ANGELA GREEN LCSW

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	101YM0800X	Mental Health Counselor	SW21225	FL
2	171M00000X	Case Manager/Care Coordinator	SW21225	FL

General Provider Information

NPI Number	:	1215822804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA GREEN LCSW

Provider Business Mailing Address
First Line	:	4740 N STATE ROAD 7 STE 201
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5839
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5800
Country	:	US
Telephone Number	:	954-735-4530
Fax Number	:

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

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	05/08/2026

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Directions to “ ANGELA GREEN LCSW” Practice Location

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