Individual
DR. M MARIE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DSW/LCSW
Contact information
Practice address
5582 S 1750 E, CRYSTAL CACOON, OGDEN, UT 84403-4388
(801) 394-3234
Mailing address
5582 S 1750 E, OGDEN, UT 84403-4388
(801) 476-8885
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1272213501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82561
PEHP
UT
Enumeration date
10/06/2006
Last updated
08/27/2007
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