Individual
GREGORY MALCOM GREEN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
701 COTTAGE GROVE RD, BLOOMFIELD, CT 06002-3080
(860) 209-0625
Mailing address
141 FIELDSTONE DR, WINDSOR, CT 06095-1663
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
005313
CT
101YM0800X
Mental Health Counselor
Primary
5313
CT
101YM0800X
Mental Health Counselor
—
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Other
Enumeration date
02/17/2022
Last updated
11/20/2023
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