MEDICARE: STEPHANIE GREEN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1568056893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE GREEN

Provider Business Mailing Address
First Line	:	231 COBBLE STONE DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22602-6871
Country	:	US
Telephone Number	:	571-919-5719
Fax Number	:	540-301-3555

Provider Business Practice Location Address
First Line	:	231 COBBLE STONE DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22602-6871
Country	:	US
Telephone Number	:	571-919-5719
Fax Number	:	540-301-3555

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

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	09/29/2025

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Directions to “ STEPHANIE GREEN ” Practice Location

Language	Start Address	Practice Location

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