Provider Demographics
NPI:1225328024
Name:GREEN, BARBARA L
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:L
Other - Last Name:HRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:62 LOYOLA AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3811
Mailing Address - Country:US
Mailing Address - Phone:312-405-0041
Mailing Address - Fax:
Practice Address - Street 1:445 BURGESS DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3442
Practice Address - Country:US
Practice Address - Phone:312-405-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical