Myranda Su Green, LLMSW
Social Worker, Clinical in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1497312904
StatusActive
Last updated in NPPESMay 21, 2019
Details
- NPI
- 1497312904
- Entity type
- Individual (NPI-1)
- Name
- Myranda Su Green
- Credential
- LLMSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 21, 2019
- Last updated
- May 21, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | MI | Yes |
Practice location
385 Leonard St NeGrand Rapids, MI 49503-1129
Phone 616-591-4891
Mailing address
385 Leonard St NeGrand Rapids, MI 49503-1129
Phone 616-591-4891
Other practice locations
160 Manley St
Holland, MI 49424-2110
Holland, MI 49424-2110
Phone 616-591-4891
799 Hombach St
Saint Ignace, MI 49781-1735
Saint Ignace, MI 49781-1735
Phone 616-591-4891
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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