Provider Demographics
NPI:1588377303
Name:GREEN, ERIN R (WY PCSW-1064)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:R
Last Name:GREEN
Suffix:
Gender:F
Credentials:WY PCSW-1064
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 THOMES AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3545
Mailing Address - Country:US
Mailing Address - Phone:307-369-4710
Mailing Address - Fax:307-222-0279
Practice Address - Street 1:1920 THOMES AVE STE 310
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3545
Practice Address - Country:US
Practice Address - Phone:307-369-4710
Practice Address - Fax:307-222-0279
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-10641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical