Provider Demographics
NPI:1508979121
Name:GREEN, LISA BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:BETH
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23250 CHAGRIN BLVD
Mailing Address - Street 2:STE 425
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-464-4243
Mailing Address - Fax:216-595-8210
Practice Address - Street 1:23250 CHAGRIN BLVD
Practice Address - Street 2:ELLEN F CASPER AND ASSOCIATES STE 425
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-464-4243
Practice Address - Fax:216-595-8210
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical