Kelly J Green, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

S.2309975 Issued in OH

Practice address

4115 Bridge Ave
Cleveland, OH 44113-3304

Phone

(216) 631-5800

Fax

(216) 631-4595

NPI assigned

Dec 1, 2021

Last updated

Feb 23, 2024By 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 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Miklat Recovery

  dba Asurgent Health

  • Adult Mental Health Clinic/Center
  • Beachwood, OH
  • NPI 1376316547
  NPD (past)

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1770241309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4819 ALBERTLY AVE",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441343323",
            "telephone_number": "440-822-5305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 BRIDGE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441133304",
            "telephone_number": "216-631-5800",
            "fax_number": "216-631-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KELLY",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-01",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.184959",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.2309975",
            "primary": true
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "0002478",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Marie Green, O.T.
• Janyra Green
• Jasmine Green
• Julianne Green
• Karen Green, DPT
• Koli Green, NP
• Kristin Green
• Lamesha Monay Green
• Leandrew Green
• Maryssa Latasha Green, RN

• Social Worker in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; 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.