MEDICARE: LINDA C GREEN LCSW INC

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	251S00000X	Community/Behavioral Health Agency	SW10749	FL

General Provider Information

NPI Number	:	1437599131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDA C GREEN LCSW INC

Provider Business Mailing Address
First Line	:	1257 SW MARTIN HWY UNIT 56
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34991-5004
Country	:	US
Telephone Number	:	772-708-7381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1257 SW MARTIN HWY UNIT 56
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34991-5004
Country	:	US
Telephone Number	:	772-708-7381
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. LINDA CONN GREEN
Credential	:	LCSW
Telephone Number	:	772-708-7381

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	06/27/2013

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