Provider Demographics
NPI:1346790102
Name:GREEN, KAMEKO (LMSW)
Entity type:Individual
Prefix:
First Name:KAMEKO
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DENVER PL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1605
Mailing Address - Country:US
Mailing Address - Phone:954-296-6942
Mailing Address - Fax:
Practice Address - Street 1:29 N HAMILTON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2541
Practice Address - Country:US
Practice Address - Phone:845-452-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094609104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker