Individual
MR. KENNETH JAMES GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2505 W 71ST ST, INDIANAPOLIS, IN 46268-2344
(317) 731-2505
Mailing address
2505 W 71ST ST, INDIANAPOLIS, IN 46268-2344
(317) 731-2505
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005965A
IN
Other
Enumeration date
04/03/2010
Last updated
08/29/2010
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