Provider Demographics
NPI:1164558235
Name:GREENE, VALINDA LAVERNE (PHD, MS,MA, RN)
Entity Type:Individual
Prefix:DR
First Name:VALINDA
Middle Name:LAVERNE
Last Name:GREENE
Suffix:
Gender:F
Credentials:PHD, MS,MA, RN
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Mailing Address - Street 1:5360 JACKSON DR
Mailing Address - Street 2:STE. 112
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6002
Mailing Address - Country:US
Mailing Address - Phone:619-697-0934
Mailing Address - Fax:619-697-5832
Practice Address - Street 1:5360 JACKSON DR
Practice Address - Street 2:STE. 112
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6002
Practice Address - Country:US
Practice Address - Phone:619-697-0934
Practice Address - Fax:619-697-5832
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY15278103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171337OtherMANAGED HEALTH NETWORK
CACP15278OtherBLUE SHEILD
CAPSY152780OtherMEDICAL PROVIDER NUMBER
CAPSY152780OtherMEDICAL PROVIDER NUMBER