Provider Demographics
NPI:1457669921
Name:GREEN, KERI JOY (MA)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:JOY
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6833 URUBU ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-5944
Mailing Address - Country:US
Mailing Address - Phone:760-809-6908
Mailing Address - Fax:
Practice Address - Street 1:2890 PIO PICO DR STE 200
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1558
Practice Address - Country:US
Practice Address - Phone:760-809-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-18
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106151106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist