Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 112137 | NY |
NPI | 1003496878 |
---|---|
Provider Name | Krista Marie Green |
First Address | Astoria, NY 11102-2729 |
Second Address | Astoria, NY 11102-2729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 14/04/2021 |