Julie Broderick Green, LCSW MFT MA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

004824 Issued in CT

Practice address

1635 Central Avenue
Southwest Connecticut Mental Health System
Bridgeport, CT 06610

Phone

(203) 551-7660

Fax

(203) 551-7481

NPI assigned

Dec 5, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386702637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 CENTRAL AVENUE ROOM 214",
            "address_2": "SOUTHWEST CT MENTAL HEALTH SYSTEM",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "06610",
            "telephone_number": "203-551-7660",
            "fax_number": "203-551-7481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 CENTRAL AVENUE",
            "address_2": "SOUTHWEST CONNECTICUT MENTAL HEALTH SYSTEM",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "06610",
            "telephone_number": "203-551-7660",
            "fax_number": "203-551-7481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JULIE",
        "middle_name": "BRODERICK",
        "name_prefix": "Ms.",
        "credential": "LCSW MFT MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "004824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Green Lotus Therapy PLLC
• Alexis Green
• Carina L Green
• Dymond Green
• Evelet Amanda Green, RN
• Serena Green, LCSW
• Tremain Green
• Green's Car Service LLC (Green's Car Services)
• Daylan Kendall Greer II, MA
• Shea C Gregg, MD

• Clinical Social Worker in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Clinical Social Worker in Connecticut

• 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.

Verify at the official NPI Registry.