Provider Demographics
NPI:1164930756
Name:GREEN, JONATHAN (LPC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 IVANHOE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2427
Mailing Address - Country:US
Mailing Address - Phone:585-364-4585
Mailing Address - Fax:
Practice Address - Street 1:207 IVANHOE AVE
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2427
Practice Address - Country:US
Practice Address - Phone:585-364-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor