Provider Demographics
NPI:1538257092
Name:GREEN, SYRETTE W (MSW)
Entity type:Individual
Prefix:MRS
First Name:SYRETTE
Middle Name:W
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 NEW PARK AVE
Mailing Address - Street 2:P.O. BOX #58
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2170
Mailing Address - Country:US
Mailing Address - Phone:860-839-2808
Mailing Address - Fax:
Practice Address - Street 1:151 NEW PARK AVE
Practice Address - Street 2:#112
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2170
Practice Address - Country:US
Practice Address - Phone:860-839-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical