Provider Demographics
NPI:1730203027
Name:GREEN, ROXANNE ALICIA (MPH)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:ALICIA
Last Name:GREEN
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:ALICIA
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH
Mailing Address - Street 1:1946 PENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-2715
Mailing Address - Country:US
Mailing Address - Phone:215-424-5563
Mailing Address - Fax:
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor