Provider Demographics
NPI:1154383271
Name:GREEN, KATHLEEN ROMAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ROMAN
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:LOUISE
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:105 PURITAN RD
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-1025
Mailing Address - Country:US
Mailing Address - Phone:412-276-7139
Mailing Address - Fax:412-276-3101
Practice Address - Street 1:485 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4350
Practice Address - Country:US
Practice Address - Phone:412-922-1566
Practice Address - Fax:412-922-3516
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7202328OtherAETNA
072377OtherMAGELLAN
211357OtherVALUE OPTIONS
334772OtherMENTAL HEALTH NETWORK
072377RH8Medicare ID - Type Unspecified
211357OtherVALUE OPTIONS