Provider Demographics
NPI:1275754624
Name:GREEN, JENNIFER A (PHD; MASTERS DEGREE)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD; MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 THORNDIKE LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4834
Mailing Address - Country:US
Mailing Address - Phone:209-701-8610
Mailing Address - Fax:
Practice Address - Street 1:4920 THORNDIKE LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4834
Practice Address - Country:US
Practice Address - Phone:209-701-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health