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Provider Information for 1063098937

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

BRENDA R GREEN LCSW, APHSW-C

Gender: FEMALE

Individual NPI: 1063098937

Calendar   Last Updated:  2021-03-22
  Certification Date:  2021-03-22

Details

Name Value
NPI 1063098937
Enumeration Date 2021-03-22
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 576 GENESEE AVE
STATEN ISLAND, NY 10312-3121
United States

Phone: 917-734-9294 | Fax:
View Map External Link
Primary Practice Address 576 GENESEE AVE
STATEN ISLAND, NY 10312-3121
United States

Phone: 917-734-9294 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1041C0700X - Social Worker Clinical NY 091065
No 1041C0700X - Social Worker Clinical NY 091065-01