| Doctor Name: | MS. MARY ALICE GREEN |
| NPI Number: | 1023165537 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | MH2905 |
| Business Practice Address: | 1299 Bedford Dr Suite A Melbourne, FL - 329401900 |
| Business Phone Number: | 3212591662 |
| Business Fax Number: | 3212591223 |
| Mailing Address: | 1299 Bedford Dr, Suite A MELBOURNE |
| State: | FL |
| Postal Code: | 329401900 |
| Phone Number: | 3212591662 |
| Fax Number: | 3212591223 |
| NPI Enumeration Date: | 01/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH2905 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |