MEDICARE: MR. JONAH DAVID GREEN MSW

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	1041C0700X	Clinical Social Worker	09449	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922113992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONAH DAVID GREEN MSW

Provider Business Mailing Address
First Line	:	3930 KNOWLES AVENUE
Second Line	:	SUITE 200
City	:	KENSINGTON
State	:	MD
Zip	:	20895
Country	:	US
Telephone Number	:	301-466-9526
Fax Number	:	301-949-0677

Provider Business Practice Location Address
First Line	:	3930 KNOWLES AVE STE 200
Second Line	:	SUITE 200
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2428
Country	:	US
Telephone Number	:	301-967-7567
Fax Number	:	301-949-0677

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/14/2012

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