Provider Demographics
NPI:1578593646
Name:GREEN, PHILLIP STEWART (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:STEWART
Last Name:GREEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19710 VENTURA BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2636
Mailing Address - Country:US
Mailing Address - Phone:818-999-9663
Mailing Address - Fax:818-999-9670
Practice Address - Street 1:19710 VENTURA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2636
Practice Address - Country:US
Practice Address - Phone:818-999-9663
Practice Address - Fax:818-999-9670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS35211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical