Individual
MELISSA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
709 CASSIUS AVE, YOUNGSTOWN, OH 44505-3464
(330) 717-4460
Mailing address
709 CASSIUS AVE, YOUNGSTOWN, OH 44505-3464
(330) 717-4460
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
7803324
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0265879
—
OH
Enumeration date
12/21/2020
Last updated
12/21/2020
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