MEDICARE: CLEONESE DASENT-GREEN

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	:	1255217691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEONESE DASENT-GREEN

Provider Business Mailing Address
First Line	:	44 APPLE ST STE 9
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-2672
Country	:	US
Telephone Number	:	732-598-3528
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 APPLE ST STE 9
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-2672
Country	:	US
Telephone Number	:	732-598-3528
Fax Number	:

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	10/17/2025

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Directions to “ CLEONESE DASENT-GREEN ” Practice Location

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