Individual provider · Type 1 NPI
Jonathan Green, LPC
Mental Health Counselor · Camillus, NY
NPI number
1164930756
Active
Practice location
207 Ivanhoe Ave
Camillus, NY 13031-2427
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | C9648 (OR) |
| Mental Health Counselor | 101YM0800X | TPMC8496 (FL) |
| Mental Health Counselor | 101YM0800X | LPC.0017554 (CO) |
Mental Health Counselor: Definition to come...
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About NPI 1164930756
Jonathan Green, LPC's National Provider Identifier is 1164930756, issued on Jan 17, 2018. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Camillus, NY. The record was last updated on Oct 26, 2026.