Active NPI
Maxine A Green, LICSW
- Clinical Social Worker
- Great Barrington, MA
National Provider Identifier
1154478188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 107394
- Practice address
- 60 Cottage St
Main St Human Resources Brien Center
Great Barrington, MA 01230-1302 - Phone
- (413) 528-9155
- Fax
- (413) 528-8187
- NPI assigned
- Jan 4, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 107394 | MA | Primary |
| Clinical Social Worker | 1041C0700X | PR020946-1 | NY |
Addresses
Primary practice location
60 Cottage St
Main St Human Resources Brien Center
Great Barrington, MA 01230-1302
Mailing address
PO Box 519
Stephentown, NY 12168-0519
Phone (518) 733-9714
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31728 | Other | MA | HEALTH NEW ENGLAND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107394 | MA | MD | Clinical Social Worker |
| PR020946-1 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Brien Center for Mental Health and Substance Abuse Services Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Pittsfield, MA
- NPI 1518984251
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154478188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 519",
"city": "STEPHENTOWN",
"state": "NY",
"postal_code": "121680519",
"telephone_number": "518-733-9714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 COTTAGE ST",
"address_2": "MAIN ST HUMAN RESOURCES BRIEN CENTER",
"city": "GREAT BARRINGTON",
"state": "MA",
"postal_code": "012301302",
"telephone_number": "413-528-9155",
"fax_number": "413-528-8187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "MAXINE",
"middle_name": "A",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "107394",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "PR020946-1",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NEW ENGLAND",
"identifier": "31728",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Barrington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.