Provider Demographics
NPI:1487998563
Name:GREEN, LINDA CONN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CONN
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SW COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1909
Mailing Address - Country:US
Mailing Address - Phone:772-708-7381
Mailing Address - Fax:772-320-0180
Practice Address - Street 1:1100 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3823
Practice Address - Country:US
Practice Address - Phone:772-320-0770
Practice Address - Fax:772-320-0180
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL107491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical