Provider Demographics
NPI:1306020755
Name:GREEN, TONSINETTA D (LCSW)
Entity Type:Individual
Prefix:
First Name:TONSINETTA
Middle Name:D
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 TREEMONT PL APT 302
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7819
Mailing Address - Country:US
Mailing Address - Phone:951-329-1336
Mailing Address - Fax:
Practice Address - Street 1:400 RAMONA AVE STE 212
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1443
Practice Address - Country:US
Practice Address - Phone:951-523-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA161301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical