MEDICARE: CAROLINE 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	101YM0800X	Mental Health Counselor	LMHC5000971	MA
2	101Y00000X	Counselor
3	101YM0800X	Mental Health Counselor	MHC01497	RI

General Provider Information

NPI Number	:	1912591017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GREEN

Provider Business Mailing Address
First Line	:	267 MAIN ST APT 3
Second Line	:
City	:	EAST GREENWICH
State	:	RI
Zip	:	02818-3759
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 SAN MATEO BLVD NE APT 1072
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2609
Country	:	US
Telephone Number	:	617-840-5239
Fax Number	:

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

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	10/03/2025

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Directions to “ CAROLINE GREEN ” Practice Location

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