Provider Demographics
NPI:1265815971
Name:GREEN, SHERRIKA (PSYD)
Entity Type:Individual
Prefix:
First Name:SHERRIKA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2283 INTERNATIONAL BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5043
Mailing Address - Country:US
Mailing Address - Phone:510-866-3091
Mailing Address - Fax:
Practice Address - Street 1:2283 INTERNATIONAL BLVD APT 208
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5043
Practice Address - Country:US
Practice Address - Phone:510-866-3091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA32511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811185259Medicaid
CA1689863516Medicaid