Elizabeth Green
Individual provider Active NPI Clinical Social Worker · Old Lyme, CT
NPI 1780125328 · NPPES record last updated Mar 15, 2017
Key facts
- NPI
- 1780125328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 58318 (TX)
- Practice address
- 55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534 - Phone
- (800) 370-3651
- Fax
- (877) 515-7147
- NPI assigned
- Mar 15, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170323001259 | TX | Practitioner - Clinical Social Worker | 1951686401 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Clinical | Current |
Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
700 Milam St
Ste 1300
Houston, TX 77002
Phone (281) 801-8391
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 58318 | TX | Yes |
Addresses
Primary practice location
55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534
Mailing address
55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534
Phone (800) 370-3651
Other providers in Old Lyme, CT
- Shragit Glazman
- Jeffrey Stuart Goldblatt
- Karl M Goldkamp
- Mark Gombotz
- Jay Allan Graves
- Ruth E Greenblatt
- Joel Greenwood
- Mary Elizabeth Groth
- Sharon Hallahan
- Kristin Hambidge
All providers in Old Lyme, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.