MEDICARE: KATE GREEN LMHC

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	101YM0800X	Mental Health Counselor	8629	MA

General Provider Information

NPI Number	:	1760171839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE GREEN LMHC

Provider Business Mailing Address
First Line	:	114 HASKELL AVE
Second Line	:
City	:	CLINTON
State	:	MA
Zip	:	01510-2734
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 HAZELWOOD RD
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-1550
Country	:	US
Telephone Number	:	774-314-1152
Fax Number	:

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

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	05/04/2023

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