Provider Demographics
NPI:1447007034
Name:GREEN, CLAUDELLE (LCSW)
Entity type:Individual
Prefix:
First Name:CLAUDELLE
Middle Name:
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 1:40 CARLISLE CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2778
Mailing Address - Country:US
Mailing Address - Phone:732-221-8490
Mailing Address - Fax:
Practice Address - Street 1:4209 ROUTE 516
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-7026
Practice Address - Country:US
Practice Address - Phone:732-290-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCC056455001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical