Basic Information
| Provider Information | |||||||||
| NPI: | 1487998563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | CONN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 SW COVERED BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | PALM CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349901909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7727087381 | ||||||||
| FaxNumber: | 7723200180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 SE FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349943823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723200770 | ||||||||
| FaxNumber: | 7723200180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10749 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.