MEDICARE: MS. MAGGIE JEAN GREENE ED.M., LPC, NCC

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	101YP2500X	Professional Counselor	002323	CT

General Provider Information

NPI Number	:	1497197263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAGGIE JEAN GREENE ED.M., LPC, NCC

Provider Business Mailing Address
First Line	:	64 WINTONBURY AVE
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2522
Country	:	US
Telephone Number	:	860-243-1007
Fax Number	:	860-243-1007

Provider Business Practice Location Address
First Line	:	64 WINTONBURY AVE
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2522
Country	:	US
Telephone Number	:	860-243-1007
Fax Number	:	860-243-1007

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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