Green Door, Inc.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD33367 Issued in DC

Legal business name

GREEN DOOR, INC.

Practice address

1221 Taylor St NW
Washington, DC 20011-5617

Phone

(202) 464-9200

Fax

(202) 464-5740

NPI assigned

Jan 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Clancy

Title

Deputy Director

Phone

(202) 464-9200

Specialties & licenses 1

Addresses

Other identifiers 3

Tax ID family

Green Door Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Green Door, Inc

  • Clinical Social Worker
  • Washington, DC
  • NPI 1982740056
  NPD tax ID
• Green Door, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Washington, DC
  • NPI 1790821866
  NPD tax ID
• Green Door, Inc.

  • Professional Counselor
  • Washington, DC
  • NPI 1891841391
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Ault, M.D.

  • Psychiatry Physician
  • Washington, DC
  • NPI 1942342399
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073659140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 TAYLOR ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200115617",
            "telephone_number": "202-464-9200",
            "fax_number": "202-464-5740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 TAYLOR ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200115617",
            "telephone_number": "202-464-9200",
            "fax_number": "202-464-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN DOOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLANCY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "202-464-9200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "DC",
            "license": "MD33367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHARTERED HEALTH PLAN",
            "identifier": "23653",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP (MEDICAID MCO)",
            "identifier": "281810",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHRIGHT (MEDICAID MCO",
            "identifier": "5181",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greater Washington Urban League Aging & Health
• Aston Barrington Greaves, D.D.S
• Austin Greaves, PSY.D.
• Green Door Behavioral Health
• Green Door, Inc
• Green Door, Inc.
• Green Door, Inc.
• Michael Green II
• Alison Tressa Green Imbergamo, MS, CCC-SLP
• Amy E Green-Simms, M.D.

• Psychiatry Physician in Washington, DC
• Providers in Washington, DC by specialty
• Psychiatry Physician in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.