Gregory Malcom Green Sr., LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

5313 Issued in CT

Practice address

701 Cottage Grove Rd
Bloomfield, CT 06002-3080

Phone

(860) 209-0625

NPI assigned

Feb 17, 2022

Last updated

Nov 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1645056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1861147902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 FIELDSTONE DR",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060951663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023080",
            "telephone_number": "860-209-0625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "141 Fieldstone Drive",
            "address_purpose": "LOCATION",
            "city": "Windsor",
            "state": "CT",
            "postal_code": "06095",
            "country_code": "US",
            "telephone_number": "857-636-0470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "GREGORY",
        "middle_name": "MALCOM",
        "name_suffix": "Sr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-17",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CT",
            "license": "005313",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CT",
            "license": "5313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Robert Allen Green, MD
• Maggie Jean Greene, ED.M., LPC, NCC
• Lori L Greenwald, M.D.
• Marilyn Gross, PT
• Layth Haddad, MA,CCC-SLP

• Mental Health Counselor in Bloomfield, CT
• Providers in Bloomfield, CT by specialty
• Mental Health Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; 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.