Provider Demographics
NPI:1083118715
Name:GREEN, LILLIAN JEAN (RBT)
Entity Type:Individual
Prefix:
First Name:LILLIAN JEAN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 ALA MOANA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4262
Mailing Address - Country:US
Mailing Address - Phone:808-380-4301
Mailing Address - Fax:808-585-0379
Practice Address - Street 1:270 WAIEHU BEACH RD STE 214
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1472
Practice Address - Country:US
Practice Address - Phone:808-242-7294
Practice Address - Fax:808-242-7296
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician