Provider Demographics
NPI:1508997974
Name:GREEN, ERIN JOVAN (BA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JOVAN
Last Name:GREEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 N ALLEN AVE
Mailing Address - Street 2:104
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3205
Mailing Address - Country:US
Mailing Address - Phone:562-773-3231
Mailing Address - Fax:
Practice Address - Street 1:855 N ORANGE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3333
Practice Address - Country:US
Practice Address - Phone:626-796-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist