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NPI Code Detail

MEDICARE: REBECCA GREEN LPC, LCADC

MEDICARE: REBECCA GREEN LPC, LCADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor37LC00174600NJ
2101YP2500XProfessional Counselor37PC00413600NJ

General Provider Information

NPI Number : 1366839672
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA GREEN LPC, LCADC
Provider Business Mailing Address
First Line : 36 SOUTH ST
Second Line :
City : MANASQUAN
State : NJ
Zip : 08736-3440
Country : US
Telephone Number : 732-223-4673
Fax Number :
Provider Business Practice Location Address
First Line : 36 SOUTH ST
Second Line :
City : MANASQUAN
State : NJ
Zip : 08736-3440
Country : US
Telephone Number : 732-223-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2015
Last Update Date : 04/24/2015

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Directions to “ REBECCA GREEN LPC, LCADC” Practice Location

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