MEDICARE: MS. STACY JAYE 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	1041C0700X	Clinical Social Worker	CW016181	PA

General Provider Information

NPI Number	:	1265598361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACY JAYE GREEN LCSW

Provider Business Mailing Address
First Line	:	500 COLLEGE AVE
Second Line	:	WORTH HEALTH CENTER - NORTH WING
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1306
Country	:	US
Telephone Number	:	215-803-8314
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 COLLEGE AVE
Second Line	:	WORTH HEALTH CENTER - NORTH WING
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1306
Country	:	US
Telephone Number	:	215-803-8314
Fax Number	:

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

Provider Enumeration Date	:	12/31/2006
Last Update Date	:	03/24/2016

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