MEDICARE: SEAN GREEN LMSW

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	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker	LMSW-19571	AZ

General Provider Information

NPI Number	:	1386331148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN GREEN LMSW

Provider Business Mailing Address
First Line	:	PO BOX 5002 MAIL STOP 1602
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85280
Country	:	US
Telephone Number	:	480-858-2143
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 S ASH AVE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-2812
Country	:	US
Telephone Number	:	480-858-2143
Fax Number	:

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

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/21/2023

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Directions to “ SEAN GREEN LMSW” Practice Location

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