Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003103797 |
---|---|
Provider Name | Paula Elainor Green |
First Address | Boston, MA 02163-1723 |
Second Address | Wakefield, MA 01880-5042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 01/07/2011 |