1154383271 NPI number — MS. KATHLEEN ROMAN GREEN LCSW

Table of content: MS. KATHLEEN ROMAN GREEN LCSW (NPI 1154383271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154383271 NPI number — MS. KATHLEEN ROMAN GREEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
KATHLEEN
Provider Middle Name:
ROMAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROMAN
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154383271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 PURITAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARNEGIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15106-1025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-276-7139
Provider Business Mailing Address Fax Number:
412-276-3101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
485 MANSFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15205-4350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-922-1566
Provider Business Practice Location Address Fax Number:
412-922-3516
Provider Enumeration Date:
04/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW013826 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7202328 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 072377 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 211357 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 334772 . This is a "MENTAL HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".