Justin Fendell Green, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P016409 Issued in NC

Practice address

2525 Raeford Rd Ste 2
Fayetteville, NC 28305-5091

Phone

(910) 835-6895

NPI assigned

Aug 8, 2021

Sex

Male

Sole proprietor

Yes

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

Enrolled in NC, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2010

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Integrated Behavioral Healthcare Services, PAGroup PAC ID 8729040316, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrated Behavioral Healthcare Services, PA

  • Psychologist
  • Fayetteville, NC
  • NPI 1689842551
  Medicare reassignment Care Compare group NPD
• Inspired by Change

  • Clinical Social Worker
  • Fayetteville, NC
  • NPI 1962182493
  NPD Authorized official
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  NC

  Medicare reassignment

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

{
    "created_epoch": "1628380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628380800000",
    "number": "1497429856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6480 KELMSCOT CT",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035674",
            "telephone_number": "910-835-6895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 RAEFORD RD STE 2",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055091",
            "telephone_number": "910-835-6895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JUSTIN",
        "middle_name": "FENDELL",
        "credential": "LCSWA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-08",
        "last_updated": "2021-08-08",
        "certification_date": "2021-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P016409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dayjah Green
• Freida Louise Green, MA, LPC, LCAS, NCC
• Gabriella Mackenzie Green
• Geoffrey Nathaniel Green, DO
• Gretchen Elizabeth Green, M.D.
• Karlita Green
• Kim Green, R.N.
• Melissa Green
• Michelle Dawn Green
• Stephanie Green, RN

• Clinical Social Worker in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.