JOHAN GREEN (NPI# 1619335916) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619335916 |
| Entity Type | Individual |
| Full Name | JOHAN GREEN |
| Credential | LADC |
| Practice Address |
181 Crawford Road Derby VT 05829 |
| Mailing Address |
181 Crawford Road Derby VT 05829-5356 |
| Practice Telephone | 8023346744 |
| Practice Fax Number | 8023347340 |
| Mailing Telephone | 8023346744 |
| Mailing Fax Number | 8023347455 |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2020-01-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
18658 | MA | Behavioral Health & Social Service Providers |
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
151.0134089 | VT | Behavioral Health & Social Service Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 22 Old Canal Dr, Lowell, MA 018512730 | 9784536800 | |
| 80 Jackson St, Newport, VT 058555756 | 6035932444 |
| Street Address |
181 CRAWFORD ROAD |
| City | DERBY |
| State | VT |
| Zip Code | 05829 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023316494 | Tony J Graveline | Counselor | 181 Crawford Road, Derby, VT 05829 | 2011-03-08 |
| 1194331355 | Claudia M Alexander | Social Worker | 181 Crawford Road, Derby, VT 05829 | 2020-09-22 |
| 1366088825 | Marie N Mcgregor | Counselor | 181 Crawford Road, Derby, VT 05829 | 2019-11-20 |
| 1508428665 | Aaron Billings | Counselor | 181 Crawford Road, Derby, VT 05829 | 2019-06-28 |
| 1467971895 | Jacqueline B Bilodeau | Social Worker | 181 Crawford Road, Derby, VT 05829 | 2017-09-18 |
| 1811417256 | Thomas J Halligan Jr. | Counselor | 181 Crawford Road, Derby, VT 05829 | 2017-06-27 |
| 1164963757 | Melissa J Deppisch | Behavioral Analyst | 181 Crawford Road, Derby, VT 05829 | 2017-03-15 |
| 1720528227 | Northeast Kingdom Human Services, Inc | Behavioral Analyst | 181 Crawford Road, Derby, VT 05829-9999 | 2017-03-02 |
| 1174066245 | Anne C Lynch | Social Worker | 181 Crawford Road, Derby, VT 05829-0000 | 2016-11-22 |
| 1083003099 | Nancy C Loomis | Social Worker | 181 Crawford Road, Derby, VT 05829-0000 | 2015-01-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730535493 | Daria Therese Torrisi | Social Worker | 57 Junior High Dr, Derby, VT 05829 | 2016-05-11 |
| 1962810598 | Mary J Gagne | Pharmacist | 115 Seymour Drive, Wal-mart Pharmacy, Derby, VT 05829 | 2014-07-28 |
| 1972938991 | Michael Thomas Kentoski | Pharmacist | 4408 U.S. Route 5, Derby, VT 05829 | 2013-09-10 |
| 1144434051 | Robert Charles Ianni Jr. | Pharmacist | 4408 Us Route 5, Derby, VT 05829 | 2007-05-09 |
| 1710029806 | Edward H. Stonebraker | Chiropractor | 562 Main Street, Derby, VT 05829 | 2007-02-13 |
| 1669547576 | Dennis E. Leblanc, D.d.s. | Dentist | 296 Main St., Derby, VT 05829 | 2006-11-24 |
| 1588139463 | Brandon Vanasse Dmd Pllc | Clinic/Center | 296 Main Street, Derby, VT 05829 | 2018-10-08 |
| 1124479662 | Brandon Vanasse | Dentist | 296 Main Street, Derby, VT 05829 | 2016-06-27 |
| 1497831275 | Dennis E Leblanc | Dentist | 296 Main St, Derby, VT 05829 | 2006-10-27 |
| 1588112809 | Wal-mart Stores East Lp | Technician/Technologist | 5228 East Main St., Debry, VT 05829-0000 | 2016-09-15 |
| Find all providers in zip 05829 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720612591 | Elizabeth Belen | Counselor | 15 Mason St, Derby, CT 06418-1420 | 2020-03-02 |
| 1376906487 | Glenn Sherwood | Counselor | 425 N Baltimore Ave Ste 1, Derby, KS 67037-1625 | 2016-04-05 |
| 1538505573 | Deborah Sue Bianchi | Counselor | 3212 Us Route 5, Derby, VT 05829-9677 | 2013-05-16 |
| 1023316494 | Tony J Graveline | Counselor | 181 Crawford Road, Derby, VT 05829 | 2011-03-08 |
| 1619115946 | Katrinka Sherron Ivie | Counselor | 119 S Baltimore Ave, Derby, KS 67037-1403 | 2009-01-23 |
| 1518116201 | Maryellen Gallagher | Counselor | 130 Division St., Griffin Hospital, Derby, CT 06418 | 2008-09-17 |
| 1760680177 | Glenn K Sherwood | Counselor | 421 N Baltimore Ave Ste 1, Derby, KS 67037-1605 | 2007-07-06 |
| 1366088825 | Marie N Mcgregor | Counselor | 181 Crawford Road, Derby, VT 05829 | 2019-11-20 |
| 1811417256 | Thomas J Halligan Jr. | Counselor | 181 Crawford Road, Derby, VT 05829 | 2017-06-27 |
| 1134506504 | Nek Counseling and Consultation | Counselor | 3212 Us Route 5, Derby, VT 05829-9677 | 2015-05-05 |
| Find all providers in DERBY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.