Provider Demographics
NPI:1275021305
Name:GREEN, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 7TH AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10123-0402
Mailing Address - Country:US
Mailing Address - Phone:212-279-7770
Mailing Address - Fax:212-279-7771
Practice Address - Street 1:450 7TH AVE STE 408
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10123-0402
Practice Address - Country:US
Practice Address - Phone:212-279-7770
Practice Address - Fax:212-279-7771
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator