Provider Demographics
NPI:1205028313
Name:GREEN, LINDA WRIGHT
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:WRIGHT
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 SAN PABLO AVE APT 1103
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3700
Mailing Address - Country:US
Mailing Address - Phone:510-499-4760
Mailing Address - Fax:
Practice Address - Street 1:13700 SAN PABLO AVE APT 1103
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3700
Practice Address - Country:US
Practice Address - Phone:510-499-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health