MEDICARE: CAROLINE KILEY GREEN LGPC

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	LGPC200001695	DC

General Provider Information

NPI Number	:	1225856065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE KILEY GREEN LGPC

Provider Business Mailing Address
First Line	:	1700 IRVING ST NW APT 302
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 14TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-3402
Country	:	US
Telephone Number	:	240-387-9054
Fax Number	:

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

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	10/01/2024

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Directions to “ CAROLINE KILEY GREEN LGPC” Practice Location

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