Organization
GREEN DOOR, INC
Active
Organization
GREEN DOOR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CLANCY (DEPUTY DIRECTOR)
(202) 464-9200
Entity
Organization
Contact information
Practice address
1221 TAYLOR ST NW, WASHINGTON, DC 20011-5617
(202) 464-9200
Mailing address
1221 TAYLOR ST NW, WASHINGTON, DC 20011-5617
(202) 464-9200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC302086
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23345
CHARTERED HEALTH PLAN MCO
DC
01
—
52113
AMERIGROUP (MEDICAID MCO)
DC
01
—
5234
HEALTHRIGHT (MEDICAID MCO
DC
Enumeration date
01/29/2007
Last updated
08/22/2020
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